Provider Demographics
NPI:1053118356
Name:GAYTAN, GABRIELLA CRYSTAL
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:CRYSTAL
Last Name:GAYTAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 A ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-3820
Mailing Address - Country:US
Mailing Address - Phone:308-631-3591
Mailing Address - Fax:
Practice Address - Street 1:1720 8TH AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2507
Practice Address - Country:US
Practice Address - Phone:308-225-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider