Provider Demographics
NPI:1144557703
Name:GIBBONS, HARRIETTE
Entity type:Individual
Prefix:MRS
First Name:HARRIETTE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HARRIETTA
Other - Middle Name:
Other - Last Name:BECKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1709 E 174TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-1753
Mailing Address - Country:US
Mailing Address - Phone:914-346-6639
Mailing Address - Fax:718-502-9366
Practice Address - Street 1:1709 E 174TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-1753
Practice Address - Country:US
Practice Address - Phone:914-346-6639
Practice Address - Fax:718-502-9366
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY449255163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse