Provider Demographics
NPI:1548283039
Name:MCGRORTY BUCHHOLZ, GERALDINE LOUISE I (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:LOUISE
Last Name:MCGRORTY BUCHHOLZ
Suffix:I
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1638 W WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1638 W WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1512
Practice Address - Country:US
Practice Address - Phone:262-473-8593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI125330-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health