Provider Demographics
NPI:1053913061
Name:GIBSON, LYNN (MA , SELF PROVIDER)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA , SELF PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3039
Mailing Address - Country:US
Mailing Address - Phone:419-466-2273
Mailing Address - Fax:
Practice Address - Street 1:4847 WOODLAND LN
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3039
Practice Address - Country:US
Practice Address - Phone:419-466-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care