Basic Information
| Provider Information | |||||||||
| NPI: | 1497909840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RACKLEY | ||||||||
| FirstName: | GISELLE | ||||||||
| MiddleName: | GABRIELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.N.I.M. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIANO | ||||||||
| OtherFirstName: | GISELLE | ||||||||
| OtherMiddleName: | GABRIELLE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9046 BARKWOOD | ||||||||
| Address2: | |||||||||
| City: | UNIVERSAL CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781484642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108581968 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2150 TOWN SQUARE PL STE 290 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774791643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817686730 | ||||||||
| FaxNumber: | 2817686766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2008 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | C.N.I.M. #999 | TX | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic | 374J00000X | N | Nursing Service Related Providers | Doula |
No ID Information.