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NPI Code Detail

MEDICARE: MRS. CYNTHIA M GJERDE RN

MEDICARE: MRS. CYNTHIA M GJERDE RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WA0400XAddiction (Substance Use Disorder) Registered Nurse1644WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346380656
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CYNTHIA M GJERDE RN
Provider Business Mailing Address
First Line : 9645 W VAN BECK AVE
Second Line :
City : GREENFIELD
State : WI
Zip : 53228-2156
Country : US
Telephone Number : 414-545-0631
Fax Number :
Provider Business Practice Location Address
First Line : 4800 S 10TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-2412
Country : US
Telephone Number : 414-744-5370
Fax Number : 414-744-9052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 07/09/2007

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