Provider Demographics
NPI:1538484407
Name:GJERSETH, TERI S (CNM, APNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:S
Last Name:GJERSETH
Suffix:
Gender:F
Credentials:CNM, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:505 GOPHER DR
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-4513
Practice Address - Country:US
Practice Address - Phone:608-372-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4404-33363LF0000X
WINM148848-032367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538484407Medicaid
WI4404-33OtherADVANCE PRACTICE NURSE PRESCRIBER
IAB129556OtherADVANCED REGISTERED NURSE PRACTITIONER
CNM0142OtherAMERICAN MIDWIFERY CERTIFICATION BOARD
WI148848-032OtherCERTIFIED NURSE MIDWIFE
WI1538484407OtherNPI
CNM0142OtherAMERICAN MIDWIFERY CERTIFICATION BOARD