Provider Demographics
NPI:1235854274
Name:RUSS, GABRIELLA TAYLOR
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:TAYLOR
Last Name:RUSS
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 1:5079 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MUNNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13409-3025
Mailing Address - Country:US
Mailing Address - Phone:315-750-8886
Mailing Address - Fax:
Practice Address - Street 1:5079 BROWN RD
Practice Address - Street 2:
Practice Address - City:MUNNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13409-3025
Practice Address - Country:US
Practice Address - Phone:315-750-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY828236163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics