Provider Demographics
NPI:1356331573
Name:GABRIELSON, MARY JUDE (CFNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JUDE
Last Name:GABRIELSON
Suffix:
Gender:F
Credentials:CFNP
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Mailing Address - Street 1:200 PORTER DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1524
Mailing Address - Country:US
Mailing Address - Phone:925-838-6511
Mailing Address - Fax:925-838-6544
Practice Address - Street 1:200 PORTER DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1524
Practice Address - Country:US
Practice Address - Phone:925-838-6500
Practice Address - Fax:925-838-6542
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANPF7083363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics