Provider Demographics
NPI:1821822198
Name:DREISBACH, GABRIEL PHILIP (APRN)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:PHILIP
Last Name:DREISBACH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11837 MIRACLE HILLS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4418
Mailing Address - Country:US
Mailing Address - Phone:402-218-1242
Mailing Address - Fax:
Practice Address - Street 1:11837 MIRACLE HILLS DR STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4418
Practice Address - Country:US
Practice Address - Phone:402-218-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115459363LF0000X, 207RE0101X, 2083B0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice