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Individual

SHANICE GIBBS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1934 LONGLEAF LN, GREENVILLE, NC 27858-9049
(910) 604-6332
Mailing address
1934 LONGLEAF LN, GREENVILLE, NC 27858-9049
(910) 604-6332

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
34260080
NC

Other

Enumeration date
09/22/2020
Last updated
09/22/2020
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