Doctor Name: | ANDREW GORSUCH |
NPI Number: | 1245496066 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 120816-030 |
Business Practice Address: | 505 Broadway St Baraboo, WI - 539132183 |
Business Phone Number: | 6053554200 |
Business Fax Number: | |
Mailing Address: | 505 Broadway St, Po Box 29 BARABOO |
State: | WI |
Postal Code: | 539132183 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/31/2008 |
NPI Last Update Date: | 07/31/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0808X |
License Number: | 120816-030 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |