Healthcare Provider Details

I. General information

NPI: 1336617117
Provider Name (Legal Business Name): HANNAH LAURA GERK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BELL CT
SAINT ANSGAR IA
50472-1338
US

IV. Provider business mailing address

404 BELL CT
SAINT ANSGAR IA
50472-1338
US

V. Phone/Fax

Practice location:
  • Phone: 641-590-5054
  • Fax:
Mailing address:
  • Phone: 641-590-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH-03979
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH9766
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: