Provider Demographics
NPI:1497935761
Name:GIBSON, CORINNE DOLORES (RNC)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:DOLORES
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:
Other - Last Name:HANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:175 MILITARY LN
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-2874
Practice Address - Country:US
Practice Address - Phone:276-452-1144
Practice Address - Fax:276-452-1140
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001178024163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult