Provider Demographics
NPI:1790338481
Name:LERG, GERALYN MARIE (MS RN CPTC)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:MARIE
Last Name:LERG
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Gender:F
Credentials:MS RN CPTC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:330 BARCLAY AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2525
Mailing Address - Country:US
Mailing Address - Phone:616-550-7766
Mailing Address - Fax:
Practice Address - Street 1:330 BARCLAY AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2525
Practice Address - Country:US
Practice Address - Phone:616-550-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704246712364ST0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364ST0500XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistTransplantation