Healthcare Provider Details

I. General information

NPI: 1770642068
Provider Name (Legal Business Name): BRIDGET GNADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W MORELAND BLVD
WAUKESHA WI
53188-2462
US

IV. Provider business mailing address

615 W MORELAND BLVD
WAUKESHA WI
53188-2462
US

V. Phone/Fax

Practice location:
  • Phone: 262-896-8430
  • Fax: 262-896-8387
Mailing address:
  • Phone: 262-896-8430
  • Fax: 262-896-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: