Provider Demographics
NPI:1023364296
Name:GEHRMANN, KRISTINE LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LEIGH
Last Name:GEHRMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LEIGH
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12142 BUSINESS PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-4525
Mailing Address - Country:US
Mailing Address - Phone:952-977-0500
Mailing Address - Fax:952-977-0510
Practice Address - Street 1:12142 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-4525
Practice Address - Country:US
Practice Address - Phone:952-977-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant