Individual
ANNMARIE LUCILLE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
4386 MIDDLEDALE AVE, WEST BLOOMFIELD, MI 48323-1160
(248) 420-1247
Mailing address
4386 MIDDLEDALE AVE, WEST BLOOMFIELD, MI 48323-1160
(248) 420-1247
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704202970
MI
363L00000X
Nurse Practitioner
Primary
4704202970
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659753259
—
MI
Enumeration date
06/19/2015
Last updated
09/11/2017
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