Provider Demographics
NPI:1790794329
Name:GERO-PSYCH NURSING, S.C.
Entity Type:Organization
Organization Name:GERO-PSYCH NURSING, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:SIGL
Authorized Official - Last Name:FELTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RN, APNP
Authorized Official - Phone:262-251-3808
Mailing Address - Street 1:19822 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:LANNON
Mailing Address - State:WI
Mailing Address - Zip Code:53046-9775
Mailing Address - Country:US
Mailing Address - Phone:262-251-3808
Mailing Address - Fax:
Practice Address - Street 1:19822 W GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:LANNON
Practice Address - State:WI
Practice Address - Zip Code:53046-9775
Practice Address - Country:US
Practice Address - Phone:262-251-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4-033363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty