MEDICARE: GABRIELLA MICHELLE PREWITT LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703108567	MI

General Provider Information

NPI Number	:	1487368445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA MICHELLE PREWITT LPN

Provider Business Mailing Address
First Line	:	5008 SILVERWOOD CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3372
Country	:	US
Telephone Number	:	248-770-0310
Fax Number	:

Provider Business Practice Location Address
First Line	:	5008 SILVERWOOD CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3372
Country	:	US
Telephone Number	:	248-770-0310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	01/28/2024

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