Provider Demographics
NPI:1801088695
Name:GEGARE, DEBRA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:GEGARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:BIRKHOLZ-LUEDEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4131 W LOOMIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2057
Mailing Address - Country:US
Mailing Address - Phone:414-325-7246
Mailing Address - Fax:414-325-3770
Practice Address - Street 1:1928 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2319
Practice Address - Country:US
Practice Address - Phone:920-436-9002
Practice Address - Fax:414-325-3770
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse