Provider Demographics
NPI:1598733206
Name:GERBER, SANDRA ELAINE (NNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
Last Name:GERBER
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 BEAM AVE
Mailing Address - Street 2:MATERNITY CARE DEPT.
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1126
Mailing Address - Country:US
Mailing Address - Phone:651-232-7831
Mailing Address - Fax:651-232-7826
Practice Address - Street 1:1655 BEAM AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1163
Practice Address - Country:US
Practice Address - Phone:651-232-7831
Practice Address - Fax:651-232-7826
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR080977-7363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP27064Medicare UPIN