Provider Demographics
NPI:1467285940
Name:GEHRKE, ANNALISE CLAIRE
Entity type:Individual
Prefix:
First Name:ANNALISE
Middle Name:CLAIRE
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BETHARDS DR APT 172
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8701
Mailing Address - Country:US
Mailing Address - Phone:925-818-7278
Mailing Address - Fax:
Practice Address - Street 1:2400 BETHARDS DR APT 172
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8701
Practice Address - Country:US
Practice Address - Phone:925-818-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program