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General NPI Number Information
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NPI Number | 1952210312
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Entity Type | Individual
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Provider Name | STEPHANIE GIBSON
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Gender | Female
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 6051 SWAN LAKE DR
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City | ROMULUS
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State | MI
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Zip | 48174-6317
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Country | US
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Telephone | 313-590-0384
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Fax | 734-939-0167
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Provider Business Mailing Address
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Address Line | 9315 TELEGRAPH RD
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City | REDFORD
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State | MI
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Zip | 48239-1260
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Country | US
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Telephone | 313-450-4500
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Fax | 313-450-4512
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MI
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