Individual
HEATHER GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
71169 OLD 205, EDWARDSBURG, MI 49112-9796
(574) 304-5762
Mailing address
71169 OLD 205, EDWARDSBURG, MI 49112-9796
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
G125302585744
MI
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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