Provider Demographics
NPI:1932727823
Name:TRENGA, GABRIELLE I (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:I
Last Name:TRENGA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 N MAIN ST # 744
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8799
Mailing Address - Country:US
Mailing Address - Phone:208-921-1119
Mailing Address - Fax:833-471-5282
Practice Address - Street 1:9351 W STATE ST STE 120
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-6718
Practice Address - Country:US
Practice Address - Phone:208-391-5098
Practice Address - Fax:833-471-5282
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily