Provider Demographics
NPI:1881612752
Name:GERTEISEN, GABRIELE M (ANP)
Entity type:Individual
Prefix:
First Name:GABRIELE
Middle Name:M
Last Name:GERTEISEN
Suffix:
Gender:F
Credentials:ANP
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 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:2250 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 202
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7412
Practice Address - Country:US
Practice Address - Phone:907-761-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK326363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1023179Medicaid
AK1023179Medicaid
AK161410Medicare UPIN
AKNP9834Medicaid