Provider Demographics
NPI:1831771641
Name:OLIVARES, GABRIELLE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:MARIE
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FLYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-2964
Mailing Address - Country:US
Mailing Address - Phone:585-298-3371
Mailing Address - Fax:
Practice Address - Street 1:101 FLYNNWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-2964
Practice Address - Country:US
Practice Address - Phone:585-298-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY796891163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse