Provider Demographics
NPI:1194241471
Name:GERSHONE, ANN (DNP)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:GERSHONE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 APRIL LN
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2735
Mailing Address - Country:US
Mailing Address - Phone:612-741-3704
Mailing Address - Fax:763-645-8697
Practice Address - Street 1:13111 APRIL LN
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2735
Practice Address - Country:US
Practice Address - Phone:612-741-3704
Practice Address - Fax:763-645-8697
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1352870363LP0808X
MN5404363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty