Provider Demographics
NPI:1437435898
Name:BICIGO, GINA LEE
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LEE
Last Name:BICIGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N STARGAZE DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7330
Mailing Address - Country:US
Mailing Address - Phone:920-257-4665
Mailing Address - Fax:
Practice Address - Street 1:4800 N STARGAZE DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7330
Practice Address - Country:US
Practice Address - Phone:920-257-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist