Individual
ANN T DERGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN, RN-C, APNP
Contact information
Practice address
1537 PARK PL, STE 200, GREEN BAY, WI 54304-1974
(920) 498-8650
(920) 498-0945
Mailing address
1537 PARK PL, STE 200, GREEN BAY, WI 54304-1974
(920) 498-8650
(920) 498-0945
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
1014-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000207365
MEDICARE
WI
01
—
STATE LICENSE
1014-033
WI
Enumeration date
09/20/2006
Last updated
03/07/2023
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