Provider Demographics
NPI:1821065129
Name:GEHRKE, GRETCHEN M (PA-C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:PA-C
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 J
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953
Mailing Address - Country:US
Mailing Address - Phone:207-368-5747
Mailing Address - Fax:207-368-5483
Practice Address - Street 1:26 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953
Practice Address - Country:US
Practice Address - Phone:207-368-5747
Practice Address - Fax:207-368-5747
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA294363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P54913Medicare UPIN
AP1681Medicare ID - Type Unspecified