Provider Demographics
NPI:1851761118
Name:WIMMER, GINA (RN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:WIMMER
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 1:917 GABES RD.
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:917 GABES RD
Practice Address - Street 2:
Practice Address - City:KRONENWETTER
Practice Address - State:WI
Practice Address - Zip Code:54455-9067
Practice Address - Country:US
Practice Address - Phone:715-212-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI198250-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1336247139Medicaid