Provider Demographics
NPI:1851695142
Name:FLEMING, GABRIELLE A (STNA)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:A
Last Name:FLEMING
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 STUBEN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-8255
Mailing Address - Country:US
Mailing Address - Phone:937-260-5739
Mailing Address - Fax:
Practice Address - Street 1:1403 STUBEN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-8255
Practice Address - Country:US
Practice Address - Phone:937-260-5739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400135590702376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH400135590702Medicaid