Provider Demographics
NPI:1245900026
Name:GEHRIG, JESSE T
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:T
Last Name:GEHRIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 34TH AVE S APT 1339
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5186
Mailing Address - Country:US
Mailing Address - Phone:701-306-1517
Mailing Address - Fax:
Practice Address - Street 1:2900 34TH AVE S APT 1339
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5186
Practice Address - Country:US
Practice Address - Phone:701-306-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant