Healthcare Provider Details

I. General information

NPI: 1275667800
Provider Name (Legal Business Name): KIRSTEN A GERRISH CDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 S TRUNK RD
PALMER AK
99645-5940
US

IV. Provider business mailing address

2323 S TRUNK RD
PALMER AK
99645-5940
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-6644
  • Fax: 317-667-1982
Mailing address:
  • Phone: 907-746-6644
  • Fax: 317-667-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAA33
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: