Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 9520-33 | WI |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 9520-33 | WI |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 9520 | WI |
NPI | 1376190165 |
---|---|
Provider Name | Gina M Perez |
First Address | Green Bay, WI 54301-3575 |
Second Address | Green Bay, WI 54301-3526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 05/08/2021 |