Basic Information
| Provider Information | |||||||||
| NPI: | 1720647084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5070 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | DEPEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164957341 | ||||||||
| FaxNumber: | 7166620019 | ||||||||
| Practice Location | |||||||||
| Address1: | 1280 MAIN ST 1ST FLOOR | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142091966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168848797 | ||||||||
| FaxNumber: | 7168820293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2019 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 333324-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.