Provider Demographics
NPI:1629046404
Name:GEIGER-BRONSKY, MICHELE J (MSN APNP BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:J
Last Name:GEIGER-BRONSKY
Suffix:
Gender:F
Credentials:MSN APNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:312 N 5TH AVE
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-746-9444
Mailing Address - Fax:920-746-9466
Practice Address - Street 1:312 N 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235
Practice Address - Country:US
Practice Address - Phone:920-746-9444
Practice Address - Fax:920-746-9466
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1029033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43881700Medicaid
WI43881700Medicaid
WI00017004Medicare ID - Type Unspecified