Healthcare Provider Details

I. General information

NPI: 1225962863
Provider Name (Legal Business Name): GABRIELLE SUZANNE HOLSTEIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENTON DR STE 100
CHARLESTON WV
25311-1256
US

IV. Provider business mailing address

2083 TERRY RD
SOUTH CHARLESTON WV
25309-9726
US

V. Phone/Fax

Practice location:
  • Phone: 304-306-8990
  • Fax:
Mailing address:
  • Phone: 304-989-9054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112940
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: