Provider Demographics
NPI:1477688117
Name:GIBBONS, CHERYL STRUBE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:STRUBE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-3523
Mailing Address - Country:US
Mailing Address - Phone:623-915-8763
Mailing Address - Fax:623-915-8762
Practice Address - Street 1:35 W DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-3523
Practice Address - Country:US
Practice Address - Phone:623-915-8763
Practice Address - Fax:623-915-8762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079708163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN079708OtherREG NURSE LICENSE