Healthcare Provider Details

I. General information

NPI: 1386285229
Provider Name (Legal Business Name): JULIA GABRIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 NEW HAMPSHIRE AVE
HYATTSVILLE MD
20783-4612
US

IV. Provider business mailing address

9628 52ND AVE
COLLEGE PARK MD
20740-4545
US

V. Phone/Fax

Practice location:
  • Phone: 240-670-7156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR235180
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: