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General NPI Number Information
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NPI Number | 1205233038
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Entity Type | Individual
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Provider Name | LORI HEFFNER GIBSON CPM, LM, MBC
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Gender | Female
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 4694 WESTWIND DR
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City | ROCK HILL
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State | SC
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Zip | 29732-8185
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Country | US
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Telephone | 704-607-6776
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Fax | 253-595-0866
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Provider Business Mailing Address
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Address Line | 4694 WESTWIND DR
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City | ROCK HILL
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State | SC
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Zip | 29732-8185
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Country | US
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Telephone | 704-607-6776
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Fax | 253-595-0866
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | LMW-0063
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License Number State | SC
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