Individual
CANDACE MICHELLE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4711 GOLF RD, SUITE 1250, SKOKIE, IL 60076-1224
(773) 412-6326
Mailing address
4711 GOLF RD, SKOKIE, IL 60076-1224
(773) 412-6326
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.351274
IL
363LF0000X
Family Nurse Practitioner
209011870
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209011870
IL
Other
Enumeration date
06/21/2014
Last updated
05/01/2017
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