MEDICARE: MS. KATHLEEN L GORENC PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2017025880	MO
2	363L00000X	Nurse Practitioner	10726	WI

General Provider Information

NPI Number	:	1467729764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN L GORENC PNP

Provider Business Mailing Address
First Line	:	7974 UW HEALTH CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 HIGHLAND AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53792-1002
Country	:	US
Telephone Number	:	608-263-9726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	08/07/2023

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