Provider Demographics
NPI:1982118758
Name:DICKERHOOF, GABRIELLE BARBARA (NP-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:BARBARA
Last Name:DICKERHOOF
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:GABRIELLE
Other - Middle Name:BARBARA
Other - Last Name:DICKERHOOF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2525 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 E STATE ST STE C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2479
Practice Address - Country:US
Practice Address - Phone:330-332-7807
Practice Address - Fax:330-332-7809
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF10171410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily