Provider Demographics
NPI:1194384552
Name:MONK, GABRIELLE M (RD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:M
Last Name:MONK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N EDGEHILL AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1512
Mailing Address - Country:US
Mailing Address - Phone:330-774-6181
Mailing Address - Fax:330-759-3149
Practice Address - Street 1:726 WICK AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2827
Practice Address - Country:US
Practice Address - Phone:330-747-9551
Practice Address - Fax:330-884-6120
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD08500133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered