1447840772 NPI number — MRS. VERA MONIQUE GIBSON LPCA

Table of content: MRS. VERA MONIQUE GIBSON LPCA (NPI 1447840772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447840772 NPI number — MRS. VERA MONIQUE GIBSON LPCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBSON
Provider First Name:
VERA
Provider Middle Name:
MONIQUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSENKRANS
Provider Other First Name:
VERA
Provider Other Middle Name:
MONIQUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447840772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2719 NEUSE BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-2857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-852-6446
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2719 NEUSE BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-514-9888
Provider Business Practice Location Address Fax Number:
252-514-2881
Provider Enumeration Date:
01/20/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  A16283 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)