Provider Demographics
NPI:1881268423
Name:GIBSON, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:LANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3605 SENECA CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3414
Mailing Address - Country:US
Mailing Address - Phone:530-941-0246
Mailing Address - Fax:
Practice Address - Street 1:1090 EAST CYRPESS AVE
Practice Address - Street 2:SUIT B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-223-2332
Practice Address - Fax:530-223-4723
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37728164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA454700010OtherSTAFFING