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General NPI Number Information
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NPI Number | 1508117623
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Entity Type | Individual
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Provider Name | MRS. STACEY GIBSON
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Gender | Female
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 3288 HIGHLAND AVE
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City | CINCINNATI
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State | OH
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Zip | 45213-2508
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Country | US
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Telephone | 513-550-6175
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Fax |
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Provider Business Mailing Address
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Address Line | 6525 ELWYNNE DR
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City | CINCINNATI
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State | OH
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Zip | 45236-4017
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Country | US
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Telephone | 513-259-0023
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 184173
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License Number State | OH
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