Provider Demographics
NPI:1356034151
Name:GIBBS, BROOKE (LPN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MI
Mailing Address - Zip Code:49266-8510
Mailing Address - Country:US
Mailing Address - Phone:517-425-4057
Mailing Address - Fax:
Practice Address - Street 1:1300 CRONK RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9461
Practice Address - Country:US
Practice Address - Phone:517-869-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703128314164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse