Provider Demographics
NPI:1407352313
Name:STANLEY, GABRIELA NICOLE (APRN-PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:NICOLE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:APRN-PMHNP
Other - Prefix:MS
Other - First Name:GABRIELA
Other - Middle Name:NICOLE
Other - Last Name:ALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-PMHNP
Mailing Address - Street 1:3600 N PROW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404
Mailing Address - Country:US
Mailing Address - Phone:812-331-8000
Mailing Address - Fax:
Practice Address - Street 1:3600 N PROW RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404
Practice Address - Country:US
Practice Address - Phone:812-331-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28224340A163W00000X
IN71012207A363LP0808X
IN2021086257363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300060532Medicaid