Healthcare Provider Details

I. General information

NPI: 1972413326
Provider Name (Legal Business Name): GABRIELLE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4947 N 66TH ST
MILWAUKEE WI
53218-4035
US

IV. Provider business mailing address

PO BOX 240783
MILWAUKEE WI
53224-9021
US

V. Phone/Fax

Practice location:
  • Phone: 292-293-6766
  • Fax:
Mailing address:
  • Phone: 292-293-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number349118
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: