Healthcare Provider Details

I. General information

NPI: 1790738706
Provider Name (Legal Business Name): BARBARA A GEHRKE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 CURTISIAN AVE
BOISE ID
83704-8801
US

IV. Provider business mailing address

5966 CURTISIAN AVE
BOISE ID
83704-8801
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-8100
  • Fax: 208-373-2643
Mailing address:
  • Phone: 208-375-8100
  • Fax: 208-373-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberN8996
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: