Provider Demographics
NPI:1316602832
Name:NESSELRODE, GABRIELLE ROSE (FNP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ROSE
Last Name:NESSELRODE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 E LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4824
Mailing Address - Country:US
Mailing Address - Phone:724-496-8229
Mailing Address - Fax:
Practice Address - Street 1:4690 E LAVENDER LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4824
Practice Address - Country:US
Practice Address - Phone:724-496-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF04210426363L00000X
AZRNP262130363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner