Healthcare Provider Details

I. General information

NPI: 1497375711
Provider Name (Legal Business Name): ANDREA LYNNE GERBERDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 ELM STREET NORTH 128A
FARGO ND
58102
US

IV. Provider business mailing address

1919 ELM ST N # 128A
FARGO ND
58102-2416
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-4151
  • Fax: 701-293-4148
Mailing address:
  • Phone: 701-293-4151
  • Fax: 701-293-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number24546
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10071943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: