Provider Demographics
NPI:1093459117
Name:GIBSON, E SUZANNE (RN)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:SUZANNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:S
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1855 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1135
Mailing Address - Country:US
Mailing Address - Phone:614-388-7931
Mailing Address - Fax:614-257-5903
Practice Address - Street 1:1855 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1135
Practice Address - Country:US
Practice Address - Phone:614-388-7931
Practice Address - Fax:614-257-5903
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN233580163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care