Provider Demographics
NPI:1043536519
Name:GABRIEL, KILEY DANIELLE
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:DANIELLE
Last Name:GABRIEL
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 1:663 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-3105
Mailing Address - Country:US
Mailing Address - Phone:419-564-7045
Mailing Address - Fax:
Practice Address - Street 1:663 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-3105
Practice Address - Country:US
Practice Address - Phone:419-564-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.128065-M-IV164W00000X
OHRN.413704163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse