Provider Demographics
NPI:1750965059
Name:ELLIES GIBBS, DELOIS S (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:DELOIS
Middle Name:S
Last Name:ELLIES GIBBS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:PO BOX 746071
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6071
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:4271 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1406
Practice Address - Country:US
Practice Address - Phone:937-971-7031
Practice Address - Fax:937-949-5839
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily