Provider Demographics
NPI:1033265822
Name:GIBSON, THELMA JOSEPHINE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:THELMA
Middle Name:JOSEPHINE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 GLOUCESTER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-4815
Mailing Address - Country:US
Mailing Address - Phone:512-926-1220
Mailing Address - Fax:
Practice Address - Street 1:918 E 32ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2704
Practice Address - Country:US
Practice Address - Phone:512-544-8195
Practice Address - Fax:512-404-8285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50215164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse