Provider Demographics
NPI:1801267356
Name:GIBNEY, NNEKA
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:GIBNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 EL RANCHO DR APT 20
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1080
Mailing Address - Country:US
Mailing Address - Phone:585-690-1440
Mailing Address - Fax:
Practice Address - Street 1:1877 EL RANCHO DR APT 22
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1080
Practice Address - Country:US
Practice Address - Phone:775-870-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV474961824320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness