Individual
SHAUNA LATIECE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
31624 N MARGINAL DR APT F, WILLOWICK, OH 44095-4422
(440) 529-9931
Mailing address
31624 N MARGINAL DR APT F, WILLOWICK, OH 44095-4422
(440) 529-9931
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/21/2019
Last updated
11/21/2019
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