Healthcare Provider Details

I. General information

NPI: 1922103134
Provider Name (Legal Business Name): GINA GERBERDING-POWLEY ANP,MSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SAINT LUKES CENTER DR STE 40
CHESTERFIELD MO
63017-3509
US

IV. Provider business mailing address

12855 N 40 DR STE 375
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-3414
  • Fax:
Mailing address:
  • Phone: 314-567-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number133208
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: