Provider Demographics
NPI:1841085495
Name:GAEDKE, ELISON RAE
Entity type:Individual
Prefix:
First Name:ELISON
Middle Name:RAE
Last Name:GAEDKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4370
Mailing Address - Country:US
Mailing Address - Phone:308-532-3965
Mailing Address - Fax:308-534-4311
Practice Address - Street 1:501 N BRYAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4370
Practice Address - Country:US
Practice Address - Phone:308-532-3965
Practice Address - Fax:308-534-4311
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker