Provider Demographics
NPI:1558630764
Name:GABRIEL, GLENNA JEANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:JEANNE
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 ROUTE 21
Mailing Address - Street 2:RED JACKET EDUCATION CENTER
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9502
Mailing Address - Country:US
Mailing Address - Phone:585-289-9649
Mailing Address - Fax:585-289-2111
Practice Address - Street 1:1506 ROUTE 21
Practice Address - Street 2:RED JACKET EDUCATION CENTER
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-9502
Practice Address - Country:US
Practice Address - Phone:585-289-9649
Practice Address - Fax:585-289-2111
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137741164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse