Healthcare Provider Details

I. General information

NPI: 1437935897
Provider Name (Legal Business Name): GABRIELLE LENORE SMERILLO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6527 LYNDALE AVE S
RICHFIELD MN
55423-1407
US

IV. Provider business mailing address

338 2ND ST NE UNIT 300
MINNEAPOLIS MN
55413-5026
US

V. Phone/Fax

Practice location:
  • Phone: 612-874-1420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10710
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: