Provider Demographics
NPI:1770166126
Name:GIERKE, SAMANTHA JANE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:GIERKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JANE
Other - Last Name:RAUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 HELEN ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1168
Mailing Address - Country:US
Mailing Address - Phone:608-643-3351
Mailing Address - Fax:
Practice Address - Street 1:112 HELEN ST
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1168
Practice Address - Country:US
Practice Address - Phone:608-643-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant