MEDICARE: JENNIFER GABO

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	363LP0200X	Pediatric Nurse Practitioner	4704322071	MI

General Provider Information

NPI Number	:	1790448736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GABO

Provider Business Mailing Address
First Line	:	3200 W LIBERTY RD STE A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 W LIBERTY RD STE A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9794
Country	:	US
Telephone Number	:	734-994-5858
Fax Number	:

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

Provider Enumeration Date	:	10/17/2021
Last Update Date	:	10/17/2021

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Directions to “ JENNIFER GABO ” Practice Location

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