Individual
TAMMI S GAGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3415 CUSTER ST, MANITOWOC, WI 54220-4324
(920) 652-9310
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2469-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1082573
NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS
—
Enumeration date
12/07/2005
Last updated
10/04/2022
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