Healthcare Provider Details

I. General information

NPI: 1366113094
Provider Name (Legal Business Name): GABRIELLE ROSE GERTNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLE DAHM

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CURVE CREST BLVD W
STILLWATER MN
55082-6040
US

IV. Provider business mailing address

1500 CURVE CREST BLVD W
STILLWATER MN
55082-6040
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-1234
  • Fax:
Mailing address:
  • Phone: 651-439-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9114-23
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14609
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: