Provider Demographics
NPI:1497055529
Name:GIBSON, ANJEANETTE (CSA)
Entity Type:Individual
Prefix:
First Name:ANJEANETTE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:POSEN
Mailing Address - State:IL
Mailing Address - Zip Code:60469-0044
Mailing Address - Country:US
Mailing Address - Phone:708-566-4584
Mailing Address - Fax:
Practice Address - Street 1:14828 ARTESIAN AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-1313
Practice Address - Country:US
Practice Address - Phone:708-566-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist