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General NPI Number Information
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NPI Number | 1528399417
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Entity Type | Individual
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Provider Name | HEIDI GINNY GEHRKE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/17/2010
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 1421 PREMIER DRIVE
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City | MANKATO
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State | MN
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Zip | 56001-5066
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Country | US
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Telephone | 507-625-1811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8674 MANKATO CLINIC 1230 E. MAIN STREET
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City | MANKATO
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State | MN
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Zip | 56001-5066
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Country | US
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Telephone | 507-625-1811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10701
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License Number State | MN
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