Provider Demographics
NPI:1134314073
Name:SIBLEY-JOHNSON, GAIL DENISE (BSN)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DENISE
Last Name:SIBLEY-JOHNSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SAN LEANDRO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1598
Mailing Address - Country:US
Mailing Address - Phone:510-481-3731
Mailing Address - Fax:
Practice Address - Street 1:1000 SAN LEANDRO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1598
Practice Address - Country:US
Practice Address - Phone:510-481-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse