Healthcare Provider Details

I. General information

NPI: 1740720358
Provider Name (Legal Business Name): ERIN BRIANA GERLOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 W EDGEWOOD DR SUITE D
JEFFERSON CITY MO
65109-5869
US

IV. Provider business mailing address

2511 W EDGEWOOD DR SUITE D
JEFFERSON CITY MO
65109-5869
US

V. Phone/Fax

Practice location:
  • Phone: 573-761-0304
  • Fax:
Mailing address:
  • Phone: 573-761-0304
  • Fax: 573-635-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017006160
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017006160
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: