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NPI Code Detail

MEDICARE: ANN T DERGE BSN, RN-C, APNP

MEDICARE: ANN T DERGE BSN, RN-C, 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
1363LW0102XWomen's Health Nurse Practitioner1014-033WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000207365OTHERWIMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2STATE LICENSEOTHERWI1014-033
3STATE LICENSEOTHERWI82393-030

General Provider Information

NPI Number : 1952409732
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN T DERGE BSN, RN-C, APNP
Provider Business Mailing Address
First Line : 1537 PARK PL
Second Line : STE 200
City : GREEN BAY
State : WI
Zip : 54304-1974
Country : US
Telephone Number : 920-498-8650
Fax Number : 920-498-0945
Provider Business Practice Location Address
First Line : 1537 PARK PL
Second Line : STE 200
City : GREEN BAY
State : WI
Zip : 54304-1974
Country : US
Telephone Number : 920-498-8650
Fax Number : 920-498-0945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 03/07/2023

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