Individual
LARRY RYAN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
509 N ELAM AVE, 2ND FL, GREENSBORO, NC 27403-1118
(336) 274-1114
(336) 232-5325
Mailing address
509 N ELAM AVE, 2ND FL, GREENSBORO, NC 27403-1118
(336) 274-1114
(336) 232-5325
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
232904
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
562140200
TAX IDENTIFICATION
NC
Enumeration date
02/16/2016
Last updated
02/16/2016
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