Healthcare Provider Details

I. General information

NPI: 1124751136
Provider Name (Legal Business Name): KRISTYN MICHELE GERCHALK TRADITIONAL MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4026 VILLA NOVA RD
PIKESVILLE MD
21207-4649
US

IV. Provider business mailing address

4026 VILLA NOVA RD
PIKESVILLE MD
21207-4649
US

V. Phone/Fax

Practice location:
  • Phone: 301-771-1373
  • Fax:
Mailing address:
  • Phone: 301-771-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: