GWEN HERZOG (NPI# 1467832667) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467832667 |
| Entity Type | Individual |
| Full Name | GWEN HERZOG |
| Credential | RN |
| Practice Address |
903 Harvey Ave Watertown WI 53094-5007 |
| Practice Telephone | 9202481723 |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2017-04-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 191155 | WI | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
7630-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
903 HARVEY AVE |
| City | WATERTOWN |
| State | WI |
| Zip Code | 53094-5007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861025371 | Addie Marie Littrell | Pharmacist | 624 S Church Street, Pharmacy Department, Watertown, WI 53094 | 2020-02-13 |
| 1144788274 | Robert Scott Johnson | Dentist | 314 W. Main St., Watertown, WI 53094 | 2019-03-07 |
| 1043785264 | Christian Long | Physical Therapist | Watertown Regional Medical Center, 1684 S Church St, Watertown, WI 53094 | 2018-10-04 |
| 1558566497 | Georgia E Meyer | Occupational Therapist | Rahab In Motion, 615 East Main St Suite B, Watertown, WI 53094 | 2007-06-20 |
| 1588789036 | Kjm Enterprises Inc | Home Health | 111 N Third Street, Watertown, WI 53094 | 2007-03-20 |
| 1114085412 | Paul R Sommers Dds Sc | Dentist | 121 Oakridge Court, Watertown, WI 53094 | 2006-12-05 |
| 1063593614 | Stein Optical Inc | Eyewear Supplier (Equipment, not the service) | 622 S Church St, Watertown, WI 53094 | 2006-10-18 |
| 1598851800 | David J Groh | Dentist | 1521 Doctors Ct, Watertown, WI 53094 | 2006-10-05 |
| 1861594251 | Robert Delano Heinen | General Practice | 700 Hoffmann Dr, Bethesda Lutheran Homes and Services, Watertown, WI 53094 | 2006-09-05 |
| 1669483897 | Donald Alan Wollheim | Surgery | 1911 Gateway Drive, Watertown, WI 53094 | 2006-08-11 |
| Find all providers in zip 53094 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043810013 | Alexa L Carolan | Nurse Practitioner | 24 Penny Ln, Watertown, CT 06795-1734 | 2020-10-29 |
| 1104433820 | Jennifer Blaze Laclair | Nurse Practitioner | 26561 State Route 3, Watertown, NY 13601-1749 | 2020-09-27 |
| 1144839549 | Kristin Nicole Hill | Nurse Practitioner | 2813 Bell Rd, Watertown, TN 37184-4716 | 2020-07-31 |
| 1811505738 | Ashley Swan | Nurse Practitioner | 1571 Washington St Ste 107, Watertown, NY 13601-9304 | 2020-07-16 |
| 1518591619 | Kelly A Blanchette | Nurse Practitioner | 204 Arsenal St Apt 489, Watertown, MA 02472-3092 | 2020-02-27 |
| 1215586854 | Ashley Rydquist | Nurse Practitioner | 926 N 4th St, Watertown, WI 53098-2915 | 2019-09-06 |
| 1184133738 | Melissa Mcintyre | Nurse Practitioner | 70 Fieldwood Rd, Watertown, CT 06795-3023 | 2017-09-27 |
| 1346783669 | Nagma Kc | Nurse Practitioner | 263 School St, Watertown, MA 02472-1412 | 2016-11-18 |
| 1477007730 | Neangkanika Chea | Nurse Practitioner | 2 Repton Place, Apt 2204, Watertown, MA 02472 | 2016-08-04 |
| 1598122947 | Charles Staples Jr. | Nurse Practitioner | 205 Sylvan Lake Rd, Watertown, CT 06779-1450 | 2016-01-15 |
| Find all providers in WATERTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.