Individual
GINA LOUISE JETZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2405 COOPER AVE, SHEBOYGAN, WI 53083-4202
(920) 946-2607
Mailing address
2405 COOPER AVE, SHEBOYGAN, WI 53083-4470
(920) 946-2607
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
310358-031
WI
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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