Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 52530-030 | WI |
NPI | 1013030071 |
---|---|
Provider Name | Mrs. Sharon L Gorsegner |
First Address | Racine, WI 53403-4209 |
Second Address | Racine, WI 53403-1523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43949900 | (05) | WI |