Provider Demographics
NPI:1477599173
Name:GIBSON, SHERI L (RN)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 PALOMINO AVE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9615
Mailing Address - Country:US
Mailing Address - Phone:937-264-1496
Mailing Address - Fax:
Practice Address - Street 1:872 PALOMINO AVE
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9615
Practice Address - Country:US
Practice Address - Phone:937-264-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.354294163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse