Provider Demographics
NPI:1962979955
Name:LANDON, GABRIELLE (CNM)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LANDON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:384 SYLVIA DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1434
Mailing Address - Country:US
Mailing Address - Phone:440-994-9962
Mailing Address - Fax:
Practice Address - Street 1:13170 RAVENNA RD STE 116
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7022
Practice Address - Country:US
Practice Address - Phone:440-285-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife