MEDICARE: MADISON GERKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	28251955A	IN
2	363LA2200X	Adult Health Nurse Practitioner	28251955A	IN
3	163WM0705X	Medical-Surgical Registered Nurse	28251955A	IN

General Provider Information

NPI Number	:	1295403517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON GERKE

Provider Business Mailing Address
First Line	:	9144 STRATHMORE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-8457
Country	:	US
Telephone Number	:	260-316-5751
Fax Number	:

Provider Business Practice Location Address
First Line	:	9144 STRATHMORE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-8457
Country	:	US
Telephone Number	:	260-316-5751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	01/24/2024

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Directions to “ MADISON GERKE ” Practice Location

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