Provider Demographics
NPI:1891163812
Name:GERBER, ROY (RN)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:GERBER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166A N PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2129
Mailing Address - Country:US
Mailing Address - Phone:414-562-2078
Mailing Address - Fax:
Practice Address - Street 1:3166A N PIERCE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2129
Practice Address - Country:US
Practice Address - Phone:414-562-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI143926163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse