Provider Demographics
NPI:1194342709
Name:GAUTHIER, ANNA JANE (APNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:JANE
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:JANE
Other - Last Name:WILHELMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-454-4101
Mailing Address - Fax:920-830-5910
Practice Address - Street 1:2500 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8735
Practice Address - Country:US
Practice Address - Phone:920-830-6877
Practice Address - Fax:920-738-4792
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10286363LF0000X
WI229918163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse