Individual
MRS. NOLA LARUE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2 MILES EAST OF BOLEY ON HWY 62, BOLEY, OK 74829
(918) 667-3367
(918) 667-3387
Mailing address
P. O. BOX 218, BOLEY, OK 74829-0218
(918) 667-3367
(918) 667-3387
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0028163
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100685660A
—
OK
05
—
100685660D
—
OK
Enumeration date
09/15/2009
Last updated
09/15/2009
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