MEDICARE: GABRIELLE ELISABETH LAWRENCE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	17226-33	WI

General Provider Information

NPI Number	:	1629957907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE ELISABETH LAWRENCE NP

Provider Business Mailing Address
First Line	:	2662 LEFEBER AVE
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2662 LEFEBER AVE
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1224
Country	:	US
Telephone Number	:	810-623-4375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	01/08/2026

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