Healthcare Provider Details

I. General information

NPI: 1861987711
Provider Name (Legal Business Name): SHARON O OGBOI-GIBSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2018
Last Update Date: 06/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 SUNNYSIDE AVE STE 222
BELTSVILLE MD
20705-2307
US

IV. Provider business mailing address

13811 CASTLE BLVD APT 22
SILVER SPRING MD
20904-7324
US

V. Phone/Fax

Practice location:
  • Phone: 240-643-7007
  • Fax:
Mailing address:
  • Phone: 240-643-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR231618
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: