MEDICARE: DENISE R GATIEN BRUX NP

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	363L00000X	Nurse Practitioner	103096	WI
2	363LF0000X	Family Nurse Practitioner	103096	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	500000913	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12658	OTHER	WI	DEAN
3	1002654	OTHER	WV	TOUCHPOINT
4	39080723684	OTHER	WI	UNITY
5	WI01N8	OTHER	WI	JOHN DEERE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770574162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE R GATIEN BRUX NP

Provider Business Mailing Address
First Line	:	420 E DIVISION ST
Second Line	:
City	:	FOND DU LAC
State	:	WI
Zip	:	54935-4560
Country	:	US
Telephone Number	:	920-926-8340
Fax Number	:

Provider Business Practice Location Address
First Line	:	723 PARK RIDGE LN
Second Line	:
City	:	NORTH FOND DU LAC
State	:	WI
Zip	:	54937-1385
Country	:	US
Telephone Number	:	920-926-8600
Fax Number	:

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	02/08/2021

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