Provider Demographics
NPI:1124211495
Name:GERSTENBERGER, EMMALEE ANNE (CNP)
Entity Type:Individual
Prefix:MS
First Name:EMMALEE
Middle Name:ANNE
Last Name:GERSTENBERGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W. IRONWOOD DRIVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4462
Mailing Address - Country:US
Mailing Address - Phone:208-667-0585
Mailing Address - Fax:208-765-6075
Practice Address - Street 1:700 W. IRONWOOD DRIVE
Practice Address - Street 2:SUITE 155
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4462
Practice Address - Country:US
Practice Address - Phone:208-667-0585
Practice Address - Fax:208-765-6075
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ID57748363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health