Provider Demographics
NPI:1619538782
Name:KOBACKER, GABRIELLE ALYSON (FNP-C)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALYSON
Last Name:KOBACKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ELIJAH JAMES DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1685
Mailing Address - Country:US
Mailing Address - Phone:207-907-9197
Mailing Address - Fax:
Practice Address - Street 1:17 BISHOP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2659
Practice Address - Country:US
Practice Address - Phone:207-618-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191153207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine