Provider Demographics
NPI:1194111658
Name:GEIST, GRETCHEN (MSN, APNP, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:GEIST
Suffix:
Gender:F
Credentials:MSN, APNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-0414
Mailing Address - Country:US
Mailing Address - Phone:920-674-5828
Mailing Address - Fax:
Practice Address - Street 1:N4810 STATE ROAD 89
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9629
Practice Address - Country:US
Practice Address - Phone:920-674-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6316 - 33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily