Provider Demographics
NPI:1184375651
Name:GIBSON, CIERRA RENEE
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:RENEE
Last Name:GIBSON
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 1:4262 7TH ST SE APT 304
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3577
Mailing Address - Country:US
Mailing Address - Phone:202-256-0481
Mailing Address - Fax:
Practice Address - Street 1:2501 25TH ST SE APT 417
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3253
Practice Address - Country:US
Practice Address - Phone:202-889-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant