Provider Demographics
NPI:1073820296
Name:GERSCHENSON, IRENE (CAC II)
Entity type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:
Last Name:GERSCHENSON
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7476 E ARKANSAS AVE APT 3909
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2549
Mailing Address - Country:US
Mailing Address - Phone:720-748-0370
Mailing Address - Fax:
Practice Address - Street 1:7476 E ARKANSAS AVE APT 3909
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2549
Practice Address - Country:US
Practice Address - Phone:720-748-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB 7167302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization