Provider Demographics
NPI:1407130529
Name:GERECKE, MARIE GUDZ (CNM)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:GUDZ
Last Name:GERECKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:GUDZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0002
Mailing Address - Country:US
Mailing Address - Phone:216-444-6601
Mailing Address - Fax:
Practice Address - Street 1:8701 DARROW RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2105
Practice Address - Country:US
Practice Address - Phone:330-888-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2275510367A00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife