Healthcare Provider Details

I. General information

NPI: 1760191027
Provider Name (Legal Business Name): AMY MARIE GABBERT CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6769 N WILLOW AVE # 101
FRESNO CA
93710-5900
US

IV. Provider business mailing address

111 W 9TH ST APT 151
CLOVIS CA
93612-1727
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-2400
  • Fax:
Mailing address:
  • Phone: 559-385-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95022972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: