Individual
MRS. SHELLY MARIE GIBBON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6116 ANNE MARIE CT, WEST BEND, WI 53095-9167
(262) 629-5190
Mailing address
6116 ANNE MARIE CT, WEST BEND, WI 53095-9167
(262) 629-5190
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
132870-30
WI
163WH0200X
Home Health Registered Nurse
132870-30
WI
163WH1000X
Hospice Registered Nurse
132870-30
WI
Other
Enumeration date
01/29/2011
Last updated
02/01/2011
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