Provider Demographics
NPI:1003971151
Name:GRESSICK, CHRISTINE SUSANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:SUSANNE
Last Name:GRESSICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5089 DAM RD
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2925
Mailing Address - Country:US
Mailing Address - Phone:262-203-0070
Mailing Address - Fax:
Practice Address - Street 1:N5089 DAM RD
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2925
Practice Address - Country:US
Practice Address - Phone:262-203-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127768-030163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39982000Medicaid