MEDICARE: MRS. GWENDOLYN M PERRY-BRYE RNC, MS, WHNP

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	363LW0102X	Women's Health Nurse Practitioner	486-033	WI
2	363L00000X	Nurse Practitioner	486-033	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568459568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GWENDOLYN M PERRY-BRYE RNC, MS, WHNP

Provider Business Mailing Address
First Line	:	3109 SOUTHWOOD DR
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-5415
Country	:	US
Telephone Number	:	262-554-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 SHERIDAN RD STE 600
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-6515
Country	:	US
Telephone Number	:	262-605-6700
Fax Number	:	262-605-6715

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	11/06/2019

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