Provider Demographics
NPI:1154536167
Name:HORMEL, GABRIELLE P (LPN)
Entity type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:P
Last Name:HORMEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 URSULAR CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1719
Mailing Address - Country:US
Mailing Address - Phone:631-979-2821
Mailing Address - Fax:
Practice Address - Street 1:7 NORMA LN
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4520
Practice Address - Country:US
Practice Address - Phone:631-804-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111831-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse