Individual
GRACIE NOEL GIBSON I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 GARDINER LN, LOUISVILLE, KY 40205-2962
(502) 413-8640
Mailing address
11385 S OLD BEAR CREEK RD, PEKIN, IN 47165-8622
(812) 987-6459
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
45023393A
IN
Other
Enumeration date
08/09/2024
Last updated
08/09/2024
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