Shelly Marie Gibbon

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

132870-30 Issued in WI

Practice address

6116 Anne Marie CT
West Bend, WI 53095-9167

Phone

(262) 629-5190

NPI assigned

Jan 29, 2011

Last updated

Feb 1, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296518400000",
    "number": "1285930818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6116 ANNE MARIE CT",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959167",
            "telephone_number": "262-629-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6116 ANNE MARIE CT",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959167",
            "telephone_number": "262-629-5190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBON",
        "first_name": "SHELLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-29",
        "last_updated": "2011-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "WI",
            "license": "132870-30",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "132870-30",
            "primary": true
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "WI",
            "license": "132870-30",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer S George, DO
• Christine Gerdes, PA-C
• Janette German, S.T.
• Jessica Christine Geschke, CSAC
• Therese J Gesteland, M.D.
• Robert D Gibson
• Erik Paul Gierahn, M.D.
• James Kevin Giese, PHD
• Gigi Enterprises LLC
• Mark Alan Gilbert, OD OPTOMETRIST

• Registered Nurse in West Bend, WI
• Providers in West Bend, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.