Provider Demographics
NPI:1154170496
Name:MORTON, GABRIELLA LOUANNA
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:LOUANNA
Last Name:MORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 BLUE KNOB RD
Mailing Address - Street 2:
Mailing Address - City:MAYSEL
Mailing Address - State:WV
Mailing Address - Zip Code:25133-9762
Mailing Address - Country:US
Mailing Address - Phone:681-381-5511
Mailing Address - Fax:
Practice Address - Street 1:15 BANK STREET
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-587-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant