Provider Demographics
NPI:1497981872
Name:GAERTIG, BECKY HARLENE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:HARLENE
Last Name:GAERTIG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 MORGAN MARSH RD
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-9644
Mailing Address - Country:US
Mailing Address - Phone:920-846-0361
Mailing Address - Fax:
Practice Address - Street 1:8223 MORGAN MARSH RD
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-9644
Practice Address - Country:US
Practice Address - Phone:920-846-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI144583030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35071700Medicaid