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General NPI Number Information
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NPI Number | 1790188498
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Entity Type | Individual
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Provider Name | NICOLAI S GERHARTZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | W832 COUNTY RD S
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City | KEWASKUM
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State | WI
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Zip | 53040-1116
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Country | US
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Telephone | 262-384-0772
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 UNIVERSITY AVE APT 96
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City | MADISON
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State | WI
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Zip | 53726-3869
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Country | US
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Telephone |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 3633250
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4605-23
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License Number State | WI
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