Gloria Degenhardt, PA
Individual provider Active NPI Physician Assistant · Norwalk, WI
NPI 1114914744 · NPPES record last updated Aug 14, 2012
Key facts
- NPI
- 1114914744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1818 (WI)
- Practice address
- 200 W North St.
Norwalk, WI 54648-0225 - Phone
- (608) 654-5100
- NPI assigned
- Sep 29, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1818 | WI | MD | Pediatric Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1818 | WI | Yes |
Addresses
Primary practice location
200 W North St.
Norwalk, WI 54648-0225
Mailing address
238 Front St
Cashton, WI 54619-2002
Other providers in Norwalk, WI
All providers in Norwalk, WI · Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.