Healthcare Provider Details

I. General information

NPI: 1609647148
Provider Name (Legal Business Name): GABRIELLE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48757 STONEBRIAR DR
CANTON MI
48188-7905
US

IV. Provider business mailing address

48757 STONEBRIAR DR
CANTON MI
48188-7905
US

V. Phone/Fax

Practice location:
  • Phone: 734-276-6627
  • Fax:
Mailing address:
  • Phone: 734-276-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704415738
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703127233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: