Individual
DEBOORAH A GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28131 NEWBERRY TRAIL, LINDSTROM, MN 55045
(651) 657-3684
Mailing address
28131 NEWBERRY TRAIL, LINDSTROM, MN 55045
(651) 657-3684
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
1020292-1-AFC
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161648
UCARE
MN
01
—
49-80610
MEDICA
MN
Enumeration date
06/13/2008
Last updated
06/13/2008
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