Healthcare Provider Details

I. General information

NPI: 1750193579
Provider Name (Legal Business Name): GABRIELLE NYCOLE BLEVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

18625 W WILLIAMS RD
SURPRISE AZ
85387-1597
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1050
  • Fax: 906-372-3230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM10674
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: