Provider Demographics
NPI:1720647084
Name:GIBSON, ALLISON L (LPN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
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 1:5070 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043
Mailing Address - Country:US
Mailing Address - Phone:716-495-7341
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:1280 MAIN ST 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1966
Practice Address - Country:US
Practice Address - Phone:716-884-8797
Practice Address - Fax:716-882-0293
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333324-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse