Healthcare Provider Details

I. General information

NPI: 1083538102
Provider Name (Legal Business Name): LIBBY GNATZIG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W183S8750 RACINE AVE
MUSKEGO WI
53150-8067
US

IV. Provider business mailing address

W183S8750 RACINE AVE
MUSKEGO WI
53150-8067
US

V. Phone/Fax

Practice location:
  • Phone: 262-971-1790
  • Fax: 262-679-5222
Mailing address:
  • Phone: 262-971-1790
  • Fax: 262-679-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1113628
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: