1407130529 NPI number — MARIE GUDZ GERECKE CNM

Table of content: MARIE GUDZ GERECKE CNM (NPI 1407130529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407130529 NPI number — MARIE GUDZ GERECKE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERECKE
Provider First Name:
MARIE
Provider Middle Name:
GUDZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUDZ
Provider Other First Name:
SARAH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407130529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 EUCLID AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44195-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-444-6601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8701 DARROW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWINSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44087-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-888-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2011

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: 367A00000X , with the licence number:  2275510 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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