Provider Demographics
NPI:1316375959
Name:GIBSON-OWENS, DAWN (CNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GIBSON-OWENS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:5940 OAK POINT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4100
Mailing Address - Country:US
Mailing Address - Phone:440-988-3705
Mailing Address - Fax:440-988-7433
Practice Address - Street 1:5940 OAK POINT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4100
Practice Address - Country:US
Practice Address - Phone:440-988-3705
Practice Address - Fax:440-988-7433
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP15272363LF0000X
OHCOA-15272-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094103Medicaid
OH0094103Medicaid
OH0094103Medicaid
OH3025372Medicaid