Healthcare Provider Details

I. General information

NPI: 1174243232
Provider Name (Legal Business Name): MRS. GABRIELLE NICOLE KENDZERSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 WALMART PLZ
SYLVA NC
28779-5808
US

IV. Provider business mailing address

176 WALMART PLZ
SYLVA NC
28779-5808
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-9462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: