Provider Demographics
NPI:1881727113
Name:FUSHIANES, GERALD DENNIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DENNIS
Last Name:FUSHIANES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GOPHER DR
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-4513
Mailing Address - Country:US
Mailing Address - Phone:608-371-2181
Mailing Address - Fax:
Practice Address - Street 1:700 WEST AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-785-0940
Practice Address - Fax:608-374-0355
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10386363AM0700X
IA002256363AM0700X
HIAMD-312363AM0700X
NE1351363AM0700X
WI1811-023363A00000X, 363AM0700X
CAPA19722363AM0700X
MI5601002730363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS37293Medicare UPIN
MI0N74070Medicare ID - Type Unspecified