Healthcare Provider Details

I. General information

NPI: 1093197261
Provider Name (Legal Business Name): STEPHANIE RENEE GERDEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE RENEE COUTURE RN

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 VILLAGE SQUARE DR SUITE 100
PERRYSBURG OH
43551-1783
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FL
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-3213
  • Fax: 419-872-9549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.17576
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number17576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: