Provider Demographics
NPI:1063443976
Name:GABBERT, NANCY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:GABBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:THALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:300 13TH AVE W STE 1
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4875
Mailing Address - Country:US
Mailing Address - Phone:701-227-7579
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:300 13TH AVE W STE 1
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4875
Practice Address - Country:US
Practice Address - Phone:701-227-7579
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND347103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid
ND021455OtherBC/BS PIN
680014991OtherRR MEDICARE PIN
N21455Medicare ID - Type Unspecified
ND54523Medicaid