Provider Demographics
NPI:1629216858
Name:GIBSON, LEONORA (RN)
Entity Type:Individual
Prefix:
First Name:LEONORA
Middle Name:
Last Name:GIBSON
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 1:2810 E TRINITY MILLS RD
Mailing Address - Street 2:#121
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2545
Mailing Address - Country:US
Mailing Address - Phone:214-228-9134
Mailing Address - Fax:214-483-6240
Practice Address - Street 1:2726 RENWICK DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5928
Practice Address - Country:US
Practice Address - Phone:214-228-9134
Practice Address - Fax:214-483-6240
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740217163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health