Provider Demographics
NPI:1851661763
Name:GABLE, CONNIE LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LEE
Last Name:GABLE
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 1:317 ORTLOFF TRL NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-9102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 ORTLOFF TRL NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-9102
Practice Address - Country:US
Practice Address - Phone:952-237-2834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL46360-5164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse