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General NPI Number Information
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NPI Number | 1063465771
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Entity Type | Individual
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Provider Name | LYNNELLE RENEE GABRIEL DPM
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 265 GRIFFIN ST E
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City | AMERY
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State | WI
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Zip | 54001-1439
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Country | US
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Telephone | 715-268-0308
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Fax | 715-268-0311
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Provider Business Mailing Address
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Address Line | 265 GRIFFIN ST E
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City | AMERY
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State | WI
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Zip | 54001-1439
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Country | US
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Telephone | 715-268-8000
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Fax | 715-268-0311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 763-025
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 763-025
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License Number State | WI
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