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General NPI Number Information
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NPI Number | 1114270030
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Entity Type | Individual
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Provider Name | RHONDA LAMAR GIBSON ACNP
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Gender | Female
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 147 FOX SQUIRREL CIR
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City | COLUMBIA
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State | SC
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Zip | 29209-4478
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Country | US
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Telephone | 803-543-9401
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 BREN ROAD EAST MAIL ROUTE MN 008-B213
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City | MINNETONKA
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State | MN
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Zip | 55343
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Country | US
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Telephone | 803-543-9401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 17515
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License Number State | SC
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