Provider Demographics
NPI:1073227708
Name:ROUX, GABRIELLE NICOLE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:NICOLE
Last Name:ROUX
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 1:5001 GREEN ASH TRL
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5575
Mailing Address - Country:US
Mailing Address - Phone:248-895-2504
Mailing Address - Fax:
Practice Address - Street 1:1000 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2170
Practice Address - Country:US
Practice Address - Phone:330-725-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical