Provider Demographics
NPI:1013030071
Name:GORSEGNER, SHARON L (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:L
Last Name:GORSEGNER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-4209
Mailing Address - Country:US
Mailing Address - Phone:262-632-1242
Mailing Address - Fax:262-632-1242
Practice Address - Street 1:834 MAIN ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1523
Practice Address - Country:US
Practice Address - Phone:262-634-2060
Practice Address - Fax:262-634-7173
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52530-030363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43949900Medicaid