Healthcare Provider Details

I. General information

NPI: 1164316196
Provider Name (Legal Business Name): ALEXANDRIA L GEZELLA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRIA L ARENDT FNP-C

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WESTERN AVE
MANITOWOC WI
54220-3712
US

IV. Provider business mailing address

2300 WESTERN AVE
MANITOWOC WI
54220-3712
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-2011
  • Fax:
Mailing address:
  • Phone: 920-320-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16995
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: