Provider Demographics
NPI:1750578480
Name:GERKEN, SUSAN PATRICE (RN, NP, CNM)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PATRICE
Last Name:GERKEN
Suffix:
Gender:F
Credentials:RN, NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 ELLIOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3644
Mailing Address - Country:US
Mailing Address - Phone:516-678-1310
Mailing Address - Fax:
Practice Address - Street 1:3434 ELLIOTT BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3644
Practice Address - Country:US
Practice Address - Phone:516-678-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000036-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife