Individual
DEIDRE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1094 HANES MALL BLVD STE 1140, WINSTON SALEM, NC 27103-1309
(743) 212-7678
Mailing address
1094 HANES MALL BLVD STE 1140, WINSTON SALEM, NC 27103-1309
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5013002
NC
Other
Enumeration date
08/23/2021
Last updated
08/23/2021
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