Provider Demographics
NPI:1821085424
Name:GERHARD, LYNNETTE L (ARNP)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:L
Last Name:GERHARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:L
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2575
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-2575
Practice Address - Fax:360-428-6485
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000018367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9607805Medicaid
WA9607805Medicaid
WAAB32095Medicare ID - Type Unspecified