Provider Demographics
NPI:1043496797
Name:GIBSON, MICHAEL BENNIE (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BENNIE
Last Name:GIBSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 ROBIN HOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-7502
Mailing Address - Country:US
Mailing Address - Phone:405-329-6092
Mailing Address - Fax:
Practice Address - Street 1:1142 ROBIN HOOD LN
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-7502
Practice Address - Country:US
Practice Address - Phone:405-329-6092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0047465163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice