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General NPI Number Information
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NPI Number | 1720520315
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Entity Type | Individual
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Provider Name | GABRIELLE GRANDELL FMCHC
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Gender | Female
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 17000 PRESTON RD STE 400
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City | DALLAS
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State | TX
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Zip | 75248-1201
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Country | US
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Telephone | 972-930-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W CITYLINE DR APT 3048
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City | RICHARDSON
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State | TX
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Zip | 75082-3366
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Country | US
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Telephone | 817-715-0512
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Fax |
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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