Basic Information
Provider Information
NPI: 1639615446
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GABRYS
FirstName: STEPHANIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MSN, AGACNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 60447
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282600447
CountryCode: US
TelephoneNumber: 7033965292
FaxNumber: 7033965297
Practice Location
Address1: 8700 SUDLEY RD
Address2:  
City: MANASSAS
State: VA
PostalCode: 20110
CountryCode: US
TelephoneNumber: 7033965292
FaxNumber: 7033965297
Other Information
ProviderEnumerationDate: 01/18/2017
LastUpdateDate: 10/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X0024174346VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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