Provider Demographics
NPI:1982682738
Name:GERTISER, GERALD WILLIAM II (FNP)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:WILLIAM
Last Name:GERTISER
Suffix:II
Gender:M
Credentials:FNP
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 393
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-0393
Mailing Address - Country:US
Mailing Address - Phone:989-348-7400
Mailing Address - Fax:989-348-6268
Practice Address - Street 1:1200 W NORTH DOWN RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-7752
Practice Address - Country:US
Practice Address - Phone:989-348-7400
Practice Address - Fax:989-348-6268
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4563113Medicaid
MI5000B010130OtherBCBSM
MIS69656Medicare UPIN
MI5000B010130OtherBCBSM