Provider Demographics
NPI:1962216713
Name:GIBBS, PAIGE B (LPN)
Entity type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:B
Last Name:GIBBS
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 1:6866 LAKEVIEW BLVD APT 19211
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-6623
Mailing Address - Country:US
Mailing Address - Phone:313-200-1789
Mailing Address - Fax:
Practice Address - Street 1:6866 LAKEVIEW BLVD APT 19211
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-6623
Practice Address - Country:US
Practice Address - Phone:313-200-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703121626164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse