Healthcare Provider Details

I. General information

NPI: 1306779988
Provider Name (Legal Business Name): GABRIELLE MONICA RABURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 JORALEMON ST
BROOKLYN NY
11201-4356
US

IV. Provider business mailing address

151 S ELLIOTT PL APT 8G
BROOKLYN NY
11217-5523
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-8000
  • Fax:
Mailing address:
  • Phone: 954-632-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number760061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: