Provider Demographics
NPI:1144998584
Name:WALKER, GABRIELLE (RN)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:E
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1402 W SUNSET RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1329
Mailing Address - Country:US
Mailing Address - Phone:262-352-8935
Mailing Address - Fax:
Practice Address - Street 1:1402 W SUNSET RIDGE DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-1329
Practice Address - Country:US
Practice Address - Phone:262-352-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI241751163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse