Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 763-025 | WI |
N | 222Z00000X | Podiatrist | 763-025 | WI |
Y | 213ES0103X | Foot & Ankle Surgery | 763-025 | WI |
NPI | 1063465771 |
---|---|
Provider Name | Lynnelle Renee Gabriel |
First Address | Amery, WI 54001-1439 |
Second Address | Amery, WI 54001-1439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43240800 | (05) | WI |
U71642 | (02) | TX |