Individual
MS. LAWANDA D GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRACTICAL NURSE
Contact information
Practice address
21415 CIVIC CENTER DR STE 302, SOUTHFIELD, MI 48076-3954
(484) 202-7023
Mailing address
19240 GAINSBOROUGH RD, DETROIT, MI 48223-1344
(313) 564-9996
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
166730
OH
164W00000X
Licensed Practical Nurse
Primary
4703119637
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G125488135293
MI STATE DRIVERS LICENSE
MI
Enumeration date
04/03/2020
Last updated
04/03/2020
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