Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | R78711 | AR |
NPI | 1013171404 |
---|---|
Provider Name | Gabrielle Rose Thrailkill |
First Address | De Queen, AR 71832-2423 |
Second Address | De Queen, AR 71832-2423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2008 |
Last Update Date | 15/07/2008 |