Provider Demographics
NPI:1730521881
Name:SNOW, GABRIELLA NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:NICOLE
Last Name:SNOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GABRIELLA
Other - Middle Name:NICOLE
Other - Last Name:BLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1309
Mailing Address - Fax:937-522-8940
Practice Address - Street 1:3095 DAYTON XENIA RD STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-4310
Practice Address - Country:US
Practice Address - Phone:937-531-7902
Practice Address - Fax:937-531-7904
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30056207Q00000X
CA144862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0422356Medicaid