Provider Demographics
NPI:1427116565
Name:BERRY, GABRIELLE STEPHANIE (CRNFA)
Entity type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:STEPHANIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:56 MAPLE ST.
Mailing Address - Street 2:P.O. BOX 87
Mailing Address - City:RIFTON
Mailing Address - State:NY
Mailing Address - Zip Code:12471-0087
Mailing Address - Country:US
Mailing Address - Phone:845-658-8835
Mailing Address - Fax:845-658-7171
Practice Address - Street 1:241 NORTH RD.
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1399
Practice Address - Country:US
Practice Address - Phone:845-431-8861
Practice Address - Fax:845-485-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286530-1163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02119111Medicaid