Provider Demographics
NPI:1255992277
Name:GIBBS-THARPE, RENE
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:GIBBS-THARPE
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 1:555 DONOFRIO DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2053
Mailing Address - Country:US
Mailing Address - Phone:608-841-1004
Mailing Address - Fax:
Practice Address - Street 1:555 DONOFRIO DR STE 3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2053
Practice Address - Country:US
Practice Address - Phone:608-841-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care