Healthcare Provider Details

I. General information

NPI: 1619363751
Provider Name (Legal Business Name): LAUREN N GABRESKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG/RAF LAKENHEATH, UNIT 5115
APO AE
09461
US

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH, UNIT 5115
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8010
  • Fax:
Mailing address:
  • Phone: 314-226-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME130554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: