Individual
REGINA VAN GORDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N., APNP, PMHNP
Contact information
Practice address
403 N GRAND AVE # 101, WAUKESHA, WI 53186-4984
(262) 300-4948
Mailing address
403 N GRAND AVE # 101, WAUKESHA, WI 53186-4984
(262) 300-4948
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
151058-30
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
13738
WI
Other
Enumeration date
05/18/2009
Last updated
03/07/2024
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