MEDICARE: GLORIA DEGENHARDT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1818	WI

General Provider Information

NPI Number	:	1114914744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA DEGENHARDT PA

Provider Business Mailing Address
First Line	:	238 FRONT ST
Second Line	:
City	:	CASHTON
State	:	WI
Zip	:	54619-2002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W NORTH ST.
Second Line	:
City	:	NORWALK
State	:	WI
Zip	:	54648-0225
Country	:	US
Telephone Number	:	608-654-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	08/14/2012

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Directions to “ GLORIA DEGENHARDT PA” Practice Location

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