Provider Demographics
NPI:1487001236
Name:NADER, GISELE
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:
Last Name:NADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 RIVIERA ST
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3724
Mailing Address - Country:US
Mailing Address - Phone:941-302-7178
Mailing Address - Fax:
Practice Address - Street 1:1133 RIVIERA ST
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3724
Practice Address - Country:US
Practice Address - Phone:941-302-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9341927163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid