Provider Demographics
NPI:1558578450
Name:BRYAN, GINA (DNP)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1310 HANOVER CT
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2646
Mailing Address - Country:US
Mailing Address - Phone:608-444-8558
Mailing Address - Fax:
Practice Address - Street 1:300 FEMRITE DR
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3798
Practice Address - Country:US
Practice Address - Phone:608-222-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132549-30163WP0808X
WI2196363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health