Provider Demographics
NPI:1609503085
Name:MARQUARDT, GAIL MARION
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MARION
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:MARION
Other - Last Name:MARQUARDT-KUJAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 DROTT ST APT 217
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-3316
Mailing Address - Country:US
Mailing Address - Phone:605-400-3902
Mailing Address - Fax:
Practice Address - Street 1:215 N 28TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4100
Practice Address - Country:US
Practice Address - Phone:715-847-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13055363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health