Provider Demographics
NPI:1205185915
Name:GERNHOFER, YAN KO (MSN, ACNP-BC, CNS)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:KO
Last Name:GERNHOFER
Suffix:
Gender:F
Credentials:MSN, ACNP-BC, CNS
Other - Prefix:
Other - First Name:YAN
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, ACNP-BC, CNS
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:619-543-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA664268163WC0200X
CA3848364SA2200X
CA22280363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHD9652OtherMEDICARE PTAN