Provider Demographics
NPI:1295816163
Name:SERDYNSKI, GEORGETTA S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGETTA
Middle Name:S
Last Name:SERDYNSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 S 54TH ST
Mailing Address - Street 2:
Mailing Address - City:W MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3404
Mailing Address - Country:US
Mailing Address - Phone:414-687-1852
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:414-687-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36016900Medicaid
WIQ72719Medicare UPIN