Provider Demographics
NPI:1295186757
Name:GIENKE, LAURA (CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GIENKE
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 1:1120 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6306
Mailing Address - Country:US
Mailing Address - Phone:440-365-2600
Mailing Address - Fax:
Practice Address - Street 1:600 KENDAL DR
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1900
Practice Address - Country:US
Practice Address - Phone:440-775-9819
Practice Address - Fax:440-775-9854
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF06161945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily