Most Relevant Information
Provider Data
| NPI Number: | 1003301821 |
| Provider Name: | STACIA GIBBS |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 743929 |
Most Important Dates
| Enumeration Date: | 06/25/2018 |
| Last Updated: | 06/25/2018 |
Provider Practice Location
6321 NEW UTRECHT AVE
BROOKLYN
NY
112195425
Practice Location Phone/Fax
| Phone: | 2126877464 |
| Fax: |
Provider Mailing Location
6321 NEW UTRECHT AVE
BROOKLYN
NY
112195425
Provider Mailing Phone/Fax
| Phone: | 2126877464 |
| Fax: |