Provider Demographics
NPI:1922071810
Name:GIBEAU, MELVA (NP AND CNS)
Entity Type:Individual
Prefix:
First Name:MELVA
Middle Name:
Last Name:GIBEAU
Suffix:
Gender:F
Credentials:NP AND CNS
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-4217
Mailing Address - Fax:843-777-4296
Practice Address - Street 1:701 CASHUA FERRY RD
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-8488
Practice Address - Country:US
Practice Address - Phone:843-777-4217
Practice Address - Fax:843-777-4296
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 1620363LA2200X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0628Medicaid
SCNP0628Medicaid
SCP78115Medicare UPIN