Provider Demographics
NPI:1225789431
Name:GABRIEAL, LATORIA (LPN)
Entity Type:Individual
Prefix:
First Name:LATORIA
Middle Name:
Last Name:GABRIEAL
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 1:1493 GATES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-9085
Mailing Address - Country:US
Mailing Address - Phone:601-596-8638
Mailing Address - Fax:
Practice Address - Street 1:127 OLD HIGHWAY 98 E STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-8172
Practice Address - Country:US
Practice Address - Phone:601-674-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS334971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse