Provider Demographics
NPI:1306509237
Name:GIBSON, MONIQUE DANIELLE (LPN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:DANIELLE
Last Name:GIBSON
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:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-0398
Mailing Address - Country:US
Mailing Address - Phone:732-677-6343
Mailing Address - Fax:
Practice Address - Street 1:9B DIAMOND DR
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2560
Practice Address - Country:US
Practice Address - Phone:732-677-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07499000164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse