Provider Demographics
NPI:1073284311
Name:BURKE, GABRIELLE HERMES (NP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:HERMES
Last Name:BURKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:ELIZABETH
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 DUDLEY ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3233
Mailing Address - Country:US
Mailing Address - Phone:401-453-7953
Mailing Address - Fax:401-453-7790
Practice Address - Street 1:100 DUDLEY ST FL 3
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3233
Practice Address - Country:US
Practice Address - Phone:401-453-7953
Practice Address - Fax:401-453-7790
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily