Individual
GARY D. HOMEIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AG-APNP-BC PMC-ED
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
(262) 948-5735
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11740
WI
363LC0200X
Critical Care Medicine Nurse Practitioner
11740-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100198240
—
WI
Enumeration date
11/08/2020
Last updated
04/22/2025
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