Provider Demographics
NPI:1790315885
Name:RANGER-MURDOCK, GABRIELLE ALEXIS (PMHNP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALEXIS
Last Name:RANGER-MURDOCK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 SATURN ST APT 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4913
Mailing Address - Country:US
Mailing Address - Phone:917-807-1098
Mailing Address - Fax:
Practice Address - Street 1:19 W 21ST ST RM 1003
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6843
Practice Address - Country:US
Practice Address - Phone:917-740-5287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY780282163WP0200X
NY403487363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics