Provider Demographics
NPI:1588493548
Name:GIBSON, DAMIEN
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 W GOWAN RD APT 1120
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7784
Mailing Address - Country:US
Mailing Address - Phone:702-357-8317
Mailing Address - Fax:702-357-8317
Practice Address - Street 1:1827 W GOWAN RD APT 1120
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7784
Practice Address - Country:US
Practice Address - Phone:702-357-8317
Practice Address - Fax:702-357-8317
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant