Healthcare Provider Details

I. General information

NPI: 1780516096
Provider Name (Legal Business Name): ANDREA GERDEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MONROE ST UNIT 103
SYLVANIA OH
43560-2771
US

IV. Provider business mailing address

5700 MONROE ST UNIT 103
SYLVANIA OH
43560-2771
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-7996
  • Fax: 419-841-7704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: