Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 604605 | CA |
NPI | 1932451853 |
---|---|
Provider Name | Ms. Carrie Gerdik |
First Address | Menifee, CA 92586-2500 |
Second Address | Valley Center, CA 92082-5338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2012 |
Last Update Date | 05/11/2019 |