Provider Demographics
NPI:1447660121
Name:GIBSON, CASSANDRA MICHELLE (LVN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MICHELLE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:MICHELLE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:5344 W AVENUE L6
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4444
Mailing Address - Country:US
Mailing Address - Phone:805-259-5517
Mailing Address - Fax:
Practice Address - Street 1:5344 W AVENUE L6
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4444
Practice Address - Country:US
Practice Address - Phone:805-259-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN238360251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care