Healthcare Provider Details

I. General information

NPI: 1629046404
Provider Name (Legal Business Name): MICHELE J GEIGER-BRONSKY MSN APNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N 5TH AVENUE
STURGEON BAY WI
54235
US

IV. Provider business mailing address

PO BOX 85 312 N 5TH AVE
STURGEON BAY WI
54235
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-9444
  • Fax: 920-746-9466
Mailing address:
  • Phone: 920-746-9444
  • Fax: 920-746-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1029033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: