Provider Demographics
NPI:1194916155
Name:GANSKE, MINDY A (PA)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:A
Last Name:GANSKE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3677
Mailing Address - Country:US
Mailing Address - Phone:414-384-6700
Mailing Address - Fax:414-384-3008
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3677
Practice Address - Country:US
Practice Address - Phone:414-384-6700
Practice Address - Fax:414-384-3008
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
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Provider Licenses
StateLicense IDTaxonomies
WI2175-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant