Provider Demographics
NPI:1376947689
Name:GIPSON, JOYLISIA RENEE
Entity Type:Individual
Prefix:
First Name:JOYLISIA
Middle Name:RENEE
Last Name:GIPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16298 EASTBURN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1427
Mailing Address - Country:US
Mailing Address - Phone:313-600-4730
Mailing Address - Fax:
Practice Address - Street 1:16298 EASTBURN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1427
Practice Address - Country:US
Practice Address - Phone:313-600-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide