Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1008-033 | WI |
N | 363L00000X | Nurse Practitioner | 118952-030 | WI |
NPI | 1013022037 |
---|---|
Provider Name | Mr. Dennis J Garvin |
First Address | Milwaukee, WI 53215-2843 |
Second Address | New Berlin, WI 53151-4063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 19/11/2021 |