Basic Information
| Provider Information | |||||||||
| NPI: | 1699446054 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NIGGEMAN | ||||||||
| FirstName: | GABRIELLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 TIMBER LN | ||||||||
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| City: | DEVON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193331248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102475290 | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152573700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2021 | ||||||||
| LastUpdateDate: | 09/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MA062995 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.