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Individual

DEONTE ALONZO GIBBS I

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MN-CNL, PMHNP-BC

Contact information

Practice address
2428 N GRANDVIEW BLVD STE 102, WAUKESHA, WI 53188-6906
(262) 875-4521
Mailing address
11221 SYNERGY DR APT 384, WAUWATOSA, WI 53222-1287
(262) 328-7925

Taxonomy

Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
239054-30
WI

Other

Enumeration date
04/20/2022
Last updated
04/20/2022
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