1346632627 NPI number — GABRIELLA ROSE BROOKSHIRE CNIM

Table of content: GABRIELLA ROSE BROOKSHIRE CNIM (NPI 1346632627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346632627 NPI number — GABRIELLA ROSE BROOKSHIRE CNIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKSHIRE
Provider First Name:
GABRIELLA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNIM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346632627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1945
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80901-1945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-888-1007
Provider Business Mailing Address Fax Number:
719-487-2689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7216 PADDLEWHEEL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWERY BRANCH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30542-7718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-275-3030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)