Provider Demographics
NPI:1558138354
Name:GABLE, JACKIE NICKOLE (CLD)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:NICKOLE
Last Name:GABLE
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 E ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-5320
Mailing Address - Country:US
Mailing Address - Phone:707-499-3637
Mailing Address - Fax:
Practice Address - Street 1:3117 E ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-5320
Practice Address - Country:US
Practice Address - Phone:707-488-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula