MEDICARE: SAMANTHA JANE GIERKE

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1770166126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JANE GIERKE

Provider Business Mailing Address
First Line	:	112 HELEN ST
Second Line	:
City	:	SAUK CITY
State	:	WI
Zip	:	53583-1168
Country	:	US
Telephone Number	:	608-643-3351
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 HELEN ST
Second Line	:
City	:	SAUK CITY
State	:	WI
Zip	:	53583-1168
Country	:	US
Telephone Number	:	608-643-3351
Fax Number	:

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

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	06/07/2023

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Directions to “ SAMANTHA JANE GIERKE ” Practice Location

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