Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 036119 | CT |
Y | 207R00000X | Internist | M10549 | ID |
Y | 111NI0900X | Internist | M10549 | ID |
N | 207R00000X | Internist | MD00024022 | WA |
N | 111NI0900X | Internist | MD00024022 | WA |
NPI | 1093891954 |
---|---|
Provider Name | Dr. Dawn Rachelle Gertson |
First Address | Coeur D Alene, ID 83814 |
Second Address | Coeur D Alene, ID 83814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 02/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C91507 | (02) |