Provider Demographics
NPI:1588651343
Name:GERLACH, JANICE D (CRNA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:D
Last Name:GERLACH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 TRAILS END
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-1531
Mailing Address - Country:US
Mailing Address - Phone:610-398-8040
Mailing Address - Fax:
Practice Address - Street 1:7915 TRAILS END
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-1531
Practice Address - Country:US
Practice Address - Phone:610-398-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN228512163W00000X
PA028742367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005419Medicare PIN
PAS48656Medicare UPIN