Provider Demographics
NPI:1497909840
Name:RACKLEY, GISELLE GABRIELLE (CNIM)
Entity Type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:GABRIELLE
Last Name:RACKLEY
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:MS
Other - First Name:GISELLE
Other - Middle Name:GABRIELLE
Other - Last Name:RIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9046 BARKWOOD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-4642
Mailing Address - Country:US
Mailing Address - Phone:210-858-1968
Mailing Address - Fax:
Practice Address - Street 1:2150 TOWN SQUARE PL STE 290
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1643
Practice Address - Country:US
Practice Address - Phone:281-768-6730
Practice Address - Fax:281-768-6766
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC.N.I.M. #999246ZE0600X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No374J00000XNursing Service Related ProvidersDoula