Provider Demographics
NPI:1831413996
Name:GIBSON, CARLA DIANE (RN,BSN)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:DIANE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 E MARKET ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6626
Mailing Address - Country:US
Mailing Address - Phone:330-841-9020
Mailing Address - Fax:330-841-9970
Practice Address - Street 1:1353 E MARKET ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6626
Practice Address - Country:US
Practice Address - Phone:330-841-9020
Practice Address - Fax:330-841-9970
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN296582163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse