Healthcare Provider Details

I. General information

NPI: 1922071810
Provider Name (Legal Business Name): MELVA GIBEAU NP AND CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CASHUA FERRY RD
DARLINGTON SC
29532-8488
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-4217
  • Fax: 843-777-4296
Mailing address:
  • Phone: 843-777-4217
  • Fax: 843-777-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN 1620
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN 1620
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: