Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 5107 | WI |
NPI | 1821624925 |
---|---|
Provider Name | Brittany Kay Gerovac |
First Address | Madison, WI 53703-2900 |
Second Address | Madison, WI 53703-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1821624925 | (05) | WI |