Doctor Name: | SHEENA GIBSON |
NPI Number: | 1467715169 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 036136764 |
Business Practice Address: | 200 E Fairman Ave Watseka, IL - 609701644 |
Business Phone Number: | 3096724809 |
Business Fax Number: | |
Mailing Address: | 200 E Fairman Ave, WATSEKA |
State: | IL |
Postal Code: | 609701644 |
Phone Number: | 3096724809 |
Fax Number: | |
NPI Enumeration Date: | 06/19/2012 |
NPI Last Update Date: | 01/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VX0000X |
License Number: | 036136764 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Obstetrics |
Taxonomy Definition: |