Individual
SHANA M GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1209 W TOKAY ST, LODI, CA 95240-3845
(209) 331-2070
Mailing address
8645 NEMEA WAY, ELK GROVE, CA 95624-3445
(623) 455-2112
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN95178653
CA
Other
Enumeration date
04/16/2019
Last updated
04/16/2019
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