Provider Demographics
NPI:1952198368
Name:FITZGERALD, GABRIEL LAVERN
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:LAVERN
Last Name:FITZGERALD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BLUE FLAME RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-3330
Mailing Address - Country:US
Mailing Address - Phone:402-937-2219
Mailing Address - Fax:
Practice Address - Street 1:418 BLUE FLAME RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-3330
Practice Address - Country:US
Practice Address - Phone:402-937-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider