Individual
GABRIELLE K MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, PHRDH
Contact information
Practice address
204 W 36TH ST, SCOTTSBLUFF, NE 69361
(308) 641-7414
Mailing address
204 W 36TH ST, SCOTTSBLUFF, NE 69361-4654
(308) 641-7414
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1976
NE
174400000X
Specialist
—
NE
Other
Enumeration date
09/27/2012
Last updated
07/08/2018
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