Provider Demographics
NPI:1235255969
Name:GIBSON WARNOCK, CAROL ANNIE (LM)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNIE
Last Name:GIBSON WARNOCK
Suffix:
Gender:F
Credentials:LM
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:GIBSON WARNOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM
Mailing Address - Street 1:247 HALL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:VT
Mailing Address - Zip Code:05443-9159
Mailing Address - Country:US
Mailing Address - Phone:802-453-4660
Mailing Address - Fax:802-453-4660
Practice Address - Street 1:247 HALL RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:VT
Practice Address - Zip Code:05443-9159
Practice Address - Country:US
Practice Address - Phone:802-453-4660
Practice Address - Fax:802-453-4660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1070000002367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008578Medicaid