Provider Demographics
NPI:1982846036
Name:KANGAS, GWYNNE C (LPN)
Entity Type:Individual
Prefix:
First Name:GWYNNE
Middle Name:C
Last Name:KANGAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 OAK LEAF DR
Mailing Address - Street 2:
Mailing Address - City:LUXEMBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54217-9114
Mailing Address - Country:US
Mailing Address - Phone:920-866-9883
Mailing Address - Fax:
Practice Address - Street 1:5415 OAK LEAF DR
Practice Address - Street 2:
Practice Address - City:LUXEMBURG
Practice Address - State:WI
Practice Address - Zip Code:54217-9114
Practice Address - Country:US
Practice Address - Phone:920-866-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI308959-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse