Provider Demographics
NPI:1699707315
Name:GJERDINGEN, DWENDA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:DWENDA
Middle Name:KAY
Last Name:GJERDINGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UFP BETHESDA CLINIC
Mailing Address - Street 2:580 RICE STREET
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103
Mailing Address - Country:US
Mailing Address - Phone:651-227-6551
Mailing Address - Fax:651-665-0684
Practice Address - Street 1:UFP BETHESDA CLINIC
Practice Address - Street 2:580 RICE STREET
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103
Practice Address - Country:US
Practice Address - Phone:651-227-6551
Practice Address - Fax:651-665-0684
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN883893300Medicaid
MN1000626OtherPREFERRED ONE
MN100517OtherUCARE
MNHP19905OtherHEALTHPARTNERS
MNODO40GJOtherBCBS
MN01-22151OtherMEDICA PRIMARY & CHOICE
MN768133OtherARAZ
MN100517OtherUCARE
MNA96137Medicare UPIN