Basic Information
| Provider Information | |||||||||
| NPI: | 1922582881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEARHART | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 LUDINGTON ST | ||||||||
| Address2: | |||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498291300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067863311 | ||||||||
| FaxNumber: | 9067864004 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 LUDINGTON ST | ||||||||
| Address2: | |||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498291300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067863311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704290041 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4704290041 | 01 | MI | STATE OF MICHIGAN NP LICENSE NUMBER | OTHER |