Healthcare Provider Details

I. General information

NPI: 1336969344
Provider Name (Legal Business Name): GABRIELLE GAYLE GRZONA MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 92ND ST
MILWAUKEE WI
53226-1202
US

IV. Provider business mailing address

W159N5506 LAVENDER LILAC LN
MENOMONEE FALLS WI
53051-6754
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3000
  • Fax:
Mailing address:
  • Phone: 262-622-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: