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General NPI Number Information
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NPI Number | 1174436745
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Entity Type | Individual
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Provider Name | SYDNEY G GERGEN
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Gender | Female
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 818 WEST ST STE 814
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City | WATERTOWN
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State | WI
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Zip | 53094-1201
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Country | US
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Telephone | 920-545-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 467 E RED PINE CIR
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City | DOUSMAN
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State | WI
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Zip | 53118-8831
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Country | US
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Telephone | 262-832-4438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WI
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