Provider Demographics
NPI:1801379714
Name:ZOLDAN, GABRIELLE WEISER (RDN)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:WEISER
Last Name:ZOLDAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N WELLS ST APT 1408
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3964
Mailing Address - Country:US
Mailing Address - Phone:330-327-3287
Mailing Address - Fax:
Practice Address - Street 1:2653 W OGDEN AVE RM 357A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:773-257-6111
Practice Address - Fax:773-257-2155
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86064806133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty