Provider Demographics
NPI:1336703339
Name:GERHARD, MORIAH ANN (LPN)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:ANN
Last Name:GERHARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 ALPINE KNL
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1738
Mailing Address - Country:US
Mailing Address - Phone:585-451-0316
Mailing Address - Fax:
Practice Address - Street 1:357 ALPINE KNL
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1738
Practice Address - Country:US
Practice Address - Phone:585-451-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321052164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse