Gabrielle K Mickelson, RDH, PHRDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

1976 Issued in NE

Practice address

204 W 36TH St
Scottsbluff, NE 69361

Phone

(308) 641-7414

NPI assigned

Sep 27, 2012

Last updated

Jul 8, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Gabrielle K Hoffman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531008000000",
    "number": "1770834970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W 36TH ST",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693614654",
            "telephone_number": "308-641-7414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W 36TH ST",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "69361",
            "telephone_number": "308-641-7414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 N Dewey St",
            "address_purpose": "LOCATION",
            "city": "North Platte",
            "state": "NE",
            "postal_code": "691015439",
            "country_code": "US",
            "telephone_number": "308-696-1201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "GABRIELLE",
        "middle_name": "K",
        "credential": "RDH, PHRDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-27",
        "last_updated": "2018-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NE",
            "license": "1976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GABRIELLE",
            "last_name": "HOFFMAN",
            "middle_name": "K",
            "credential": "RDH, PHRDH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Dental Hygienist in Scottsbluff, NE
• Providers in Scottsbluff, NE by specialty
• Dental Hygienist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.