Basic Information
Provider Information
NPI: 1265167738
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GABEL
FirstName: KRISTINE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 ELMWOOD AVE BOX 629
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5857585700
FaxNumber:  
Practice Location
Address1: 2365 S CLINTON AVE STE 200
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146182663
CountryCode: US
TelephoneNumber: 5857585700
FaxNumber: 5857581298
Other Information
ProviderEnumerationDate: 07/19/2022
LastUpdateDate: 10/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X349853NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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