Healthcare Provider Details

I. General information

NPI: 1205451564
Provider Name (Legal Business Name): GINGER RENEE BLAND APNP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINGER R MEDER

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S CURTIS ST
LAKE GENEVA WI
53147-2052
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-329-4979
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10097-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: