Provider Demographics
NPI:1891419271
Name:AZURE-WALLETTE, GABRIELLE YVETTE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:YVETTE
Last Name:AZURE-WALLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0821
Mailing Address - Country:US
Mailing Address - Phone:701-850-6059
Mailing Address - Fax:
Practice Address - Street 1:152 JOHN NORQUAY ST
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-850-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker