Individual
SHONDA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2166 CRANE AVE, CINCINNATI, OH 45207-1321
(513) 307-7424
Mailing address
2166 CRANE AVE, CINCINNATI, OH 45207-1321
(513) 307-7424
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
SD661078
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0205505
—
OH
Enumeration date
06/03/2019
Last updated
06/03/2019
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