Individual
MS. GWEN MARIE VERCHOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1500 BIRCHMONT DR. NE, BEMIDJI STATE UNIVERSITY, STUDENT CENTER FOR HEALTH, BEMIDJI, MN 56601-2699
(218) 755-2053
Mailing address
51759 219TH AVE, BEMIDJI, MN 56601-9357
(218) 755-1994
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
MN30423
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-03641
MN MEDICA
MN
05
—
2527146-00
—
MN
01
—
500014030
RAILROAD MEDICARE
—
01
—
52B87VE
MN BLUECROSS BLUESHIELD
MN
01
—
HP28500
MN HEALTHPARTNERS
MN
Enumeration date
05/23/2006
Last updated
08/06/2009
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