Individual
GWEN HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
903 HARVEY AVE, WATERTOWN, WI 53094-5007
(920) 248-1723
Mailing address
903 HARVEY AVE, WATERTOWN, WI 53094-5007
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
191155
WI
363LF0000X
Family Nurse Practitioner
Primary
7630-33
WI
Other
Enumeration date
06/02/2015
Last updated
04/13/2017
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