Provider Demographics
NPI:1821718537
Name:JACKSON, GABBRIELLE (MS, CNS)
Entity Type:Individual
Prefix:MRS
First Name:GABBRIELLE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIESLING TER UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03303-1063
Mailing Address - Country:US
Mailing Address - Phone:260-417-7430
Mailing Address - Fax:
Practice Address - Street 1:2 RIESLING TER UNIT 1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03303-1063
Practice Address - Country:US
Practice Address - Phone:260-417-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist