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NPI Code Detail

MEDICARE: MRS. KARI LYNN GONDECK APNP

MEDICARE: MRS. KARI LYNN GONDECK APNP
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
1363L00000XNurse Practitioner3145WI

General Provider Information

NPI Number : 1750571188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KARI LYNN GONDECK APNP
Provider Business Mailing Address
First Line : 1727 SHAWANO AVE
Second Line : 201
City : GREEN BAY
State : WI
Zip : 54303-3268
Country : US
Telephone Number : 920-496-8877
Fax Number : 920-496-3061
Provider Business Practice Location Address
First Line : 1727 SHAWANO AVE
Second Line : 201
City : GREEN BAY
State : WI
Zip : 54303-3268
Country : US
Telephone Number : 920-496-8877
Fax Number : 920-496-3061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2007
Last Update Date : 08/01/2007

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