=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396918355
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL MARIE GERBER COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2008
-----------------------------------------------------
Last Update Date | 04/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3130 GRIMES AVE N
-----------------------------------------------------
City | ROBBINSDALE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-588-0771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6264 CHESSHIRE LANE N
-----------------------------------------------------
City | MAPLE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-383-0809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 200149
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------