Provider Demographics
NPI:1508663188
Name:GIBSON, CHARLENE MICHELLE
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MICHELLE
Last Name:GIBSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5888 W SUNSET RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3453
Mailing Address - Country:US
Mailing Address - Phone:702-382-3030
Mailing Address - Fax:
Practice Address - Street 1:5888 W SUNSET RD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3453
Practice Address - Country:US
Practice Address - Phone:702-382-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN44898163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse