Individual
GREGORY HARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
701 GROVE AVE, WILD ROSE, WI 54984-6901
(920) 622-5560
Mailing address
701 GROVE AVE, WILD ROSE, WI 54984-6901
(920) 622-5560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
585-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42924200
—
WI
Enumeration date
09/15/2005
Last updated
04/29/2014
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