Provider Demographics
NPI:1013035484
Name:GABRIELLIQ, BRENDA SUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SUE
Last Name:GABRIELLIQ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 THISTLEDOWN CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3523
Mailing Address - Country:US
Mailing Address - Phone:856-649-3503
Mailing Address - Fax:
Practice Address - Street 1:2403 THISTLEDOWN CT
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3523
Practice Address - Country:US
Practice Address - Phone:856-649-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP04789700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse