Provider Demographics
NPI:1700543857
Name:GIBBS, SHAWNA MARIE (LPN ADON)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MARIE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LPN ADON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 JEROME LN
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2604
Mailing Address - Country:US
Mailing Address - Phone:618-337-9400
Mailing Address - Fax:618-337-9394
Practice Address - Street 1:3354 JEROME LN
Practice Address - Street 2:
Practice Address - City:CAHOKIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62206-2604
Practice Address - Country:US
Practice Address - Phone:618-337-9400
Practice Address - Fax:618-337-9394
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043104570164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse