1558630764 NPI number — MRS. GLENNA JEANNE GABRIEL LPN

Table of content: MRS. GLENNA JEANNE GABRIEL LPN (NPI 1558630764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558630764 NPI number — MRS. GLENNA JEANNE GABRIEL LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABRIEL
Provider First Name:
GLENNA
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
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:
1558630764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1506 ROUTE 21
Provider Second Line Business Mailing Address:
RED JACKET EDUCATION CENTER
Provider Business Mailing Address City Name:
SHORTSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14548-9502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-289-9649
Provider Business Mailing Address Fax Number:
585-289-2111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1506 ROUTE 21
Provider Second Line Business Practice Location Address:
RED JACKET EDUCATION CENTER
Provider Business Practice Location Address City Name:
SHORTSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14548-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-289-9649
Provider Business Practice Location Address Fax Number:
585-289-2111
Provider Enumeration Date:
12/16/2011

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: 164W00000X , with the licence number:  137741 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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