Provider Demographics
NPI:1407347990
Name:ALDERKS, GWEN KAY
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:KAY
Last Name:ALDERKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5103
Mailing Address - Country:US
Mailing Address - Phone:815-997-3493
Mailing Address - Fax:
Practice Address - Street 1:6303 5TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5103
Practice Address - Country:US
Practice Address - Phone:815-997-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula