Basic Information
Provider Information
NPI: 1023622693
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GERKEN
FirstName: ROSS
MiddleName: WILLIAM
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1900 S MAIN ST
Address2:  
City: FINDLAY
State: OH
PostalCode: 458401214
CountryCode: US
TelephoneNumber: 4194235221
FaxNumber: 4194235143
Practice Location
Address1: 1900 S MAIN ST
Address2:  
City: FINDLAY
State: OH
PostalCode: 458401214
CountryCode: US
TelephoneNumber: 4194234500
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2020
LastUpdateDate: 09/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XAPRN.CNP.0027449OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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