Provider Demographics
NPI:1629650924
Name:GERONZIN, ASHLEY JORDAN LANAE (RN)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:JORDAN LANAE
Last Name:GERONZIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 RIVERTON DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1053
Mailing Address - Country:US
Mailing Address - Phone:563-503-1968
Mailing Address - Fax:
Practice Address - Street 1:S70W20099 ADRIAN DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-8200
Practice Address - Country:US
Practice Address - Phone:262-366-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI245804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse