Provider Demographics
NPI:1679281695
Name:HEATWOLE, GABRIELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:
Last Name:HEATWOLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WAKEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-3721
Mailing Address - Country:US
Mailing Address - Phone:423-377-5216
Mailing Address - Fax:
Practice Address - Street 1:110 WAKEFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-3721
Practice Address - Country:US
Practice Address - Phone:423-377-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90779164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse