Healthcare Provider Details

I. General information

NPI: 1619560943
Provider Name (Legal Business Name): GABRIELLE LORIN MCINTYRE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. GABRIELLE LORIN BECKEMEYER

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 ORLY PL
JB MDL NJ
08641-1301
US

IV. Provider business mailing address

P.O. BOX 61
BREESE IL
62230
US

V. Phone/Fax

Practice location:
  • Phone: 618-980-8127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14869200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: