Individual
MISS TRACEY GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA
Contact information
Practice address
12855 N 40 DR, SUITE 100, SAINT LOUIS, MO 63141-8657
(314) 878-7150
(314) 878-3051
Mailing address
12855 N 40 DR, SUITE 100, SAINT LOUIS, MO 63141-8657
(314) 878-7150
(314) 878-3051
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
123572
MO
Other
Enumeration date
03/09/2009
Last updated
03/09/2009
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