Lawanda D Gibson, PRACTICAL NURSE

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703119637 Issued in MI

Practice address

21415 Civic Center Dr Ste 302
Southfield, MI 48076-3954

Phone

(484) 202-7023

NPI assigned

Apr 3, 2020

Last updated

Apr 3, 2020By 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 2

Addresses

Other identifiers 1

Other names 1

• Ms. Lawanda Dashawn Gibson Professional name

Electronic endpoints 1

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": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1558990432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19240 GAINSBOROUGH RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482231344",
            "telephone_number": "313-564-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21415 CIVIC CENTER DR STE 302",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480763954",
            "telephone_number": "484-202-7023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "LAWANDA",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "PRACTICAL NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-03",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "166730",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703119637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI STATE DRIVERS LICENSE",
            "identifier": "G125488135293",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "REST",
            "affiliation": "N",
            "endpointDescription": "HIE",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "21415 Civic Center Dr Ste 302",
            "city": "Southfield",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480763954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAWANDA",
            "last_name": "GIBSON",
            "middle_name": "DASHAWN",
            "prefix": "MS.",
            "credential": "LPN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Faith Gibbons
• Timika Gibbons
• Stephanie Gibbs
• John Eric Gibson, D.C.
• Joshua Gibson, MD
• Lindsey Gibson
• Stacy Y Gibson, DPT
• Jacqueline Gierer, D.O.
• Kierra Gietzen
• Gifted Care Agency, LLC

• Licensed Practical Nurse in Southfield, MI
• Providers in Southfield, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.