Provider Demographics
NPI:1114270030
Name:GIBSON, RHONDA LAMAR (ACNP)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:LAMAR
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BREN ROAD EAST
Mailing Address - Street 2:MAIL ROUTE MN 008-B213
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343
Mailing Address - Country:US
Mailing Address - Phone:803-543-9401
Mailing Address - Fax:
Practice Address - Street 1:147 FOX SQUIRREL CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-4478
Practice Address - Country:US
Practice Address - Phone:803-543-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17515363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care