Provider Demographics
NPI:1215521166
Name:KLINGE, GABRIELLE A
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:A
Last Name:KLINGE
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 1:441 S DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3230
Mailing Address - Country:US
Mailing Address - Phone:208-315-2627
Mailing Address - Fax:
Practice Address - Street 1:441 S DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3230
Practice Address - Country:US
Practice Address - Phone:208-315-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist