Provider Demographics
NPI:1356867568
Name:CAPASSO, GABRIELLE (RN)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:CAPASSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BOONE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5003
Mailing Address - Country:US
Mailing Address - Phone:917-636-9212
Mailing Address - Fax:718-979-6940
Practice Address - Street 1:1477 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-979-6900
Practice Address - Fax:718-979-6940
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319394164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY745971OtherRN LICENSE
NY319394OtherLPN LICENSE