Individual
MS. ELAINE MARIE GACKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
742 W HIGHLAND AVE, SAN BERNARDINO, CA 92405-3839
(909) 213-0001
(909) 386-1882
Mailing address
23021 JENSEN CT, GRAND TERRACE, CA 92313-5579
(909) 783-7933
(909) 783-7933
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP376074
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RNP376074
LICENSE
CA
Enumeration date
02/15/2006
Last updated
10/03/2011
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