1205005964 NPI number — MISS ANITA CRISTINA GIERKE OTRL

Table of content: MISS ANITA CRISTINA GIERKE OTRL (NPI 1205005964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205005964 NPI number — MISS ANITA CRISTINA GIERKE OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIERKE
Provider First Name:
ANITA
Provider Middle Name:
CRISTINA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARKASKY
Provider Other First Name:
ANITA
Provider Other Middle Name:
CRISTINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205005964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1975 BERINGER PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44041-8284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-862-4777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4533 PARK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHTABULA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-992-9441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT004269 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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