Basic Information
| Provider Information | |||||||||
| NPI: | 1154319507 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABLE | ||||||||
| FirstName: | CONSTANCE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 W HWY 50 | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812012238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302048 | ||||||||
| FaxNumber: | 7195302055 | ||||||||
| Practice Location | |||||||||
| Address1: | 28374 COUNTY ROAD 317 | ||||||||
| Address2: | |||||||||
| City: | BUENA VISTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812119158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302048 | ||||||||
| FaxNumber: | 7195302055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP5090 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 23552352 | 05 | CO | MEDICAID |