Organization
GJB EEG SERVICES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA JEAN BANNASCH (OWNER)
(920) 560-4525
Entity
Organization
Contact information
Practice address
711 N LYNNDALE DR STE 1A, APPLETON, WI 54914-3078
(920) 560-4525
(920) 560-6618
Mailing address
711 N LYNNDALE DR STE 1A, APPLETON, WI 54914-3078
(920) 560-4525
(920) 560-6618
Taxonomy
Speciality
Code
Description
License number
State
246ZE0500X
EEG Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100062778
—
WI
01
—
1528091030
STATE OF WISCONSIN
WI
Enumeration date
07/01/2021
Last updated
04/07/2023
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