Provider Demographics
NPI:1093973232
Name:GERKEN, DEEANN (MSN NPC)
Entity Type:Individual
Prefix:
First Name:DEEANN
Middle Name:
Last Name:GERKEN
Suffix:
Gender:F
Credentials:MSN NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40465 CAMINO MONECITO
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203
Mailing Address - Country:US
Mailing Address - Phone:760-774-1512
Mailing Address - Fax:
Practice Address - Street 1:72624 EL PASEO, SUITE A1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-341-3984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN121200163W00000X
AZAP1709363LF0000X
CA12214363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ062224Medicaid
AZ062224Medicaid