Provider Demographics
NPI:1083404149
Name:GIBBS, MICHAEL HOWARD
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOWARD
Last Name:GIBBS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770-0496
Mailing Address - Country:US
Mailing Address - Phone:402-755-2104
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 645
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-0645
Practice Address - Country:US
Practice Address - Phone:712-251-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider