Provider Demographics
NPI:1487896072
Name:GIBSON, NORMA JEAN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:JEAN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 WARRENSVILLE CENTER RD APT 323
Mailing Address - Street 2:.3715 WARRENSVILLE CENTER RD
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6368
Mailing Address - Country:US
Mailing Address - Phone:216-255-7403
Mailing Address - Fax:
Practice Address - Street 1:3715 WARRENSVILLE CENTER RD APT 323
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6368
Practice Address - Country:US
Practice Address - Phone:216-255-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-190615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN-190615OtherREGISTERED NURSE