Provider Demographics
NPI:1801914320
Name:NUSBAUM, GABRIELLA ANN (LPN,IP)
Entity type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:ANN
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:LPN,IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SUNNYSLOPE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2517
Mailing Address - Country:US
Mailing Address - Phone:419-756-2039
Mailing Address - Fax:
Practice Address - Street 1:37 SUNNYSLOPE DRIVE
Practice Address - Street 2:MANSFIELD,OH 44907
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2517
Practice Address - Country:US
Practice Address - Phone:419-756-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN095910164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse