Healthcare Provider Details

I. General information

NPI: 1245320571
Provider Name (Legal Business Name): GAIL HARVANCIK GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL PANAGIS

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 W FOND DU LAC AVE
MILWAUKEE WI
53216
US

IV. Provider business mailing address

W65N387 WESTLAWN AVE
CEDARBURG WI
53012
US

V. Phone/Fax

Practice location:
  • Phone: 414-536-2100
  • Fax: 414-536-2311
Mailing address:
  • Phone: 414-465-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1958033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: