Provider Demographics
NPI:1790738706
Name:GEHRKE, BARBARA A (CNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5966 CURTISIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8801
Mailing Address - Country:US
Mailing Address - Phone:208-375-8100
Mailing Address - Fax:208-373-2643
Practice Address - Street 1:5966 CURTISIAN AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8801
Practice Address - Country:US
Practice Address - Phone:208-375-8100
Practice Address - Fax:208-373-2643
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN8996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010016566OtherBLUE SHIELD
IDNPGB9OtherBLUE CROSS