Provider Demographics
NPI:1336636976
Name:GIBSON, ANNE HELEN (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:HELEN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 BULRUSH BASKET LN
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7426
Mailing Address - Country:US
Mailing Address - Phone:843-849-2809
Mailing Address - Fax:843-971-6118
Practice Address - Street 1:2705 BULRUSH BASKET LN
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7426
Practice Address - Country:US
Practice Address - Phone:843-849-2809
Practice Address - Fax:843-971-6118
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP24233164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty