Provider Demographics
NPI:1073943742
Name:GERIKE, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:GERIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W15896 SLIFER RD
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-8682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W15896 SLIFER RD
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-8682
Practice Address - Country:US
Practice Address - Phone:715-271-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306608-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse