Provider Demographics
NPI:1285954131
Name:GIPSON, FAITH ARLENE (LPN)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ARLENE
Last Name:GIPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1604
Mailing Address - Country:US
Mailing Address - Phone:716-948-9007
Mailing Address - Fax:
Practice Address - Street 1:360 DELAWARE AVE
Practice Address - Street 2:SUITE 3N
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1620
Practice Address - Country:US
Practice Address - Phone:716-948-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268372164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAQ78058QMedicaid