Provider Demographics
NPI:1205451564
Name:BLAND, GINGER RENEE (APNP FNP-BC)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:RENEE
Last Name:BLAND
Suffix:
Gender:F
Credentials:APNP FNP-BC
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:R
Other - Last Name:MEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N3354 NARCISSUS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2945
Mailing Address - Country:US
Mailing Address - Phone:262-325-9973
Mailing Address - Fax:
Practice Address - Street 1:11133 W. NATIONAL AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-327-2295
Practice Address - Fax:414-328-4497
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10097-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner