Individual
HEIDI MARIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
13654 WILLOW CREEK DR, YUCAIPA, CA 92399-6706
(909) 478-4683
Mailing address
13654 WILLOW CREEK DR, YUCAIPA, CA 92399-6706
(909) 478-4683
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
190050
CA
Other
Enumeration date
02/18/2011
Last updated
02/18/2011
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