Healthcare Provider Details

I. General information

NPI: 1699976621
Provider Name (Legal Business Name): GABRIELLE PULLEN GCFP, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/23/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W MAIN ST
JACKSONVILLE OR
97530-9278
US

IV. Provider business mailing address

P.O. BOX 7311
JACKSONVILLE OR
97530-2854
US

V. Phone/Fax

Practice location:
  • Phone: 541-777-0124
  • Fax:
Mailing address:
  • Phone: 541-777-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number25754
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: