Provider Demographics
NPI:1366027021
Name:GAETHKE, HANNAH JO (BSN RN)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:JO
Last Name:GAETHKE
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 ELM ST W
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1414
Mailing Address - Country:US
Mailing Address - Phone:608-385-3947
Mailing Address - Fax:
Practice Address - Street 1:836 ELM ST W
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1414
Practice Address - Country:US
Practice Address - Phone:608-385-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI254463163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health