Provider Demographics
NPI:1629415831
Name:GIBBS, ALICIA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:A
Last Name:GIBBS
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 1:735 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-1831
Mailing Address - Country:US
Mailing Address - Phone:803-755-7409
Mailing Address - Fax:803-755-7449
Practice Address - Street 1:735 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-1831
Practice Address - Country:US
Practice Address - Phone:803-755-7409
Practice Address - Fax:803-755-7449
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN37208163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool