Provider Demographics
NPI:1730465469
Name:GERDICH, ROBERT L (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:GERDICH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 1/2 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1013
Mailing Address - Country:US
Mailing Address - Phone:814-504-2359
Mailing Address - Fax:
Practice Address - Street 1:1014 1/2 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1013
Practice Address - Country:US
Practice Address - Phone:814-504-2359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN286250164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse