Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301088310 | MI |
N | 111NI0900X | Internist | 4301088310 | MI |
N | 208000000X | Pediatrician | 4301088310 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 54412 | WI |
N | 2080P0202X | Pediatric Cardiologist | 73516 | GA |
NPI | 1053523399 |
---|---|
Provider Name | Jennifer Faye Gerardin |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 25/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053523399 | (05) | WI |