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NPI Code Detail

MEDICARE: JUDITH A GRESKY NP

MEDICARE: JUDITH A GRESKY 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
1363L00000XNurse Practitioner4567WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000359276OTHEROHANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3344428256101OTHEROHCARESOURCE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962401794
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH A GRESKY NP
Provider Business Mailing Address
First Line : 36500 AURORA DR
Second Line :
City : SUMMIT
State : WI
Zip : 53066-4899
Country : US
Telephone Number : 262-434-1000
Fax Number :
Provider Business Practice Location Address
First Line : 36500 AURORA DR
Second Line :
City : SUMMIT
State : WI
Zip : 53066-4899
Country : US
Telephone Number : 262-434-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 01/11/2018

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Directions to “ JUDITH A GRESKY NP” Practice Location

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