Provider Demographics
NPI:1629082367
Name:GERSHWIN, MADELINE W (RN)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:W
Last Name:GERSHWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91908-0627
Mailing Address - Country:US
Mailing Address - Phone:619-400-5187
Mailing Address - Fax:619-400-5154
Practice Address - Street 1:8810 RIO SAN DIEGO DR
Practice Address - Street 2:116A4Z
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1622
Practice Address - Country:US
Practice Address - Phone:619-400-5187
Practice Address - Fax:619-400-5154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 195997364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health