Healthcare Provider Details

I. General information

NPI: 1568459568
Provider Name (Legal Business Name): GWENDOLYN M PERRY-BRYE RNC, MS, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 SHERIDAN RD STE 600
KENOSHA WI
53143-6515
US

IV. Provider business mailing address

3109 SOUTHWOOD DR
RACINE WI
53406-5415
US

V. Phone/Fax

Practice location:
  • Phone: 262-605-6700
  • Fax: 262-605-6715
Mailing address:
  • Phone: 262-554-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number486-033
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number486-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: