Provider Demographics
NPI:1689213258
Name:GERFEN, JENNIFER ALEXANDRIA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALEXANDRIA
Last Name:GERFEN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28808 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56063-4130
Mailing Address - Country:US
Mailing Address - Phone:509-366-5331
Mailing Address - Fax:
Practice Address - Street 1:28808 W LAKE DR
Practice Address - Street 2:
Practice Address - City:MADISON LAKE
Practice Address - State:MN
Practice Address - Zip Code:56063-4130
Practice Address - Country:US
Practice Address - Phone:509-366-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1077176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
19110017OtherNORTH AMERICAN REGISTRY OF MIDWIVES
MN1077OtherTRADITIONAL MIDWIFE LICENSE