Provider Demographics
NPI:1811370794
Name:GIBBONS, ORIENDA
Entity Type:Individual
Prefix:
First Name:ORIENDA
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 172ND ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3437
Mailing Address - Country:US
Mailing Address - Phone:917-803-7298
Mailing Address - Fax:718-658-7319
Practice Address - Street 1:11020 172ND ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3437
Practice Address - Country:US
Practice Address - Phone:917-803-7298
Practice Address - Fax:718-658-7319
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5402351163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool