Healthcare Provider Details

I. General information

NPI: 1881998185
Provider Name (Legal Business Name): PHYLLIS ANNE GIBSON MS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 E ELLSWORTH RD
ANN ARBOR MI
48108-2552
US

IV. Provider business mailing address

2140 E ELLSWORTH RD
ANN ARBOR MI
48108-2552
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-9556
  • Fax:
Mailing address:
  • Phone: 734-222-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704168464
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: