Provider Demographics
NPI:1871341537
Name:GERSTENBERGER, VICKY (RN)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:GERSTENBERGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SEAMON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6336
Mailing Address - Country:US
Mailing Address - Phone:207-778-3561
Mailing Address - Fax:207-778-3564
Practice Address - Street 1:129 SEAMON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6336
Practice Address - Country:US
Practice Address - Phone:207-778-3561
Practice Address - Fax:207-778-3564
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN47412163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool