Healthcare Provider Details

I. General information

NPI: 1073452322
Provider Name (Legal Business Name): GABRIELL HALEE PETRI HANCOCK APRN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 N WASHINGTON ST STE F
BISMARCK ND
58501-7604
US

IV. Provider business mailing address

1929 N WASHINGTON ST STE F
BISMARCK ND
58501-7604
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-0066
  • Fax: 701-712-0077
Mailing address:
  • Phone: 701-712-0066
  • Fax: 701-712-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number204103
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number204103
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: