Provider Demographics
NPI:1083713648
Name:GERNER, CHARLENE ANN (PA)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANN
Last Name:GERNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:320 3RD AVENUE
Mailing Address - Street 2:CENTRACARE CLINIC ALBANY
Mailing Address - City:ALBANY
Mailing Address - State:MN
Mailing Address - Zip Code:56307-9363
Mailing Address - Country:US
Mailing Address - Phone:320-845-2157
Mailing Address - Fax:320-845-6138
Practice Address - Street 1:320 3RD AVENUE
Practice Address - Street 2:CENTRACARE CLINIC ALBANY
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9363
Practice Address - Country:US
Practice Address - Phone:320-845-2157
Practice Address - Fax:320-845-6138
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110374OtherUCARE
MN893552100Medicaid
MN00F98COOtherBLUE CROSS
MN0119057OtherMEDICA
MN1011384OtherPREFERRED ONE
MNHP10274OtherHEALTH PARTNERS
MNHP10274OtherHEALTH PARTNERS
MN970000343Medicare ID - Type Unspecified