Individual
GABRIELLE MARIE WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
74 S MAIN ST STE 103, FOND DU LAC, WI 54935-4274
(920) 924-5222
Mailing address
74 S MAIN ST STE 103, FOND DU LAC, WI 54935-4274
(920) 924-5222
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/17/2024
Last updated
01/17/2024
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