Provider Demographics
NPI:1376296756
Name:GABORIAU, MALYNN BERRY (MSN, APRN, NNP-BC)
Entity Type:Individual
Prefix:
First Name:MALYNN
Middle Name:BERRY
Last Name:GABORIAU
Suffix:
Gender:F
Credentials:MSN, APRN, NNP-BC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:MALYNN
Other - Last Name:BERRY GABORIAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 PEAK COPPER CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-5901
Mailing Address - Country:US
Mailing Address - Phone:803-582-8794
Mailing Address - Fax:
Practice Address - Street 1:TAYLOR AT MARION STREETS
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220-0001
Practice Address - Country:US
Practice Address - Phone:803-296-5709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225895163WN0002X
SC25884363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care