Provider Demographics
NPI:1831074285
Name:GAMBONI, KERRIE SUE (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MRS
First Name:KERRIE
Middle Name:SUE
Last Name:GAMBONI
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 GASLYN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-8969
Mailing Address - Country:US
Mailing Address - Phone:715-416-2529
Mailing Address - Fax:
Practice Address - Street 1:2673 GASLYN CREEK RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8969
Practice Address - Country:US
Practice Address - Phone:715-416-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3320-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered