MEDICARE: GLORIA J. NACHREINER PAC

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	1014	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780674929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA J. NACHREINER PAC

Provider Business Mailing Address
First Line	:	1040 DIVISION ST
Second Line	:
City	:	MAUSTON
State	:	WI
Zip	:	53948-1931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 W BRIDGE ST
Second Line	:
City	:	NEW LISBON
State	:	WI
Zip	:	53950-1083
Country	:	US
Telephone Number	:	608-562-3111
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	06/28/2010

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