Provider Demographics
NPI:1881725745
Name:GEGEN, JANA LYNNE (APRN)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:LYNNE
Last Name:GEGEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W12377 COUNTY ROAD MM
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-7011
Mailing Address - Country:US
Mailing Address - Phone:651-398-2459
Mailing Address - Fax:
Practice Address - Street 1:1100 BERGSLIEN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-2600
Practice Address - Country:US
Practice Address - Phone:715-684-1111
Practice Address - Fax:715-684-1119
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 176124-1163WH0200X
WI9615-33363LF0000X, 363LP0808X
MN6852363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4J19CAOtherBCBS
MN37865OtherHEALTH PARNTERS
MN5900010OtherMEDICA
MN181585OtherUCARE MN PCA
MN106502OtherUCARE MN
MN148313700Medicaid
MN411770668OtherVA FED. GOV.