Individual
KATHLEEN RAE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1496 W HOOSIER BLVD, PERU, IN 46970-3727
(765) 472-5032
(765) 472-8999
Mailing address
1496 W HOOSIER BLVD, PERU, IN 46970-3727
(765) 472-5032
(765) 472-8999
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27056635A
IN
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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