Individual
VICKIE CHRISTINE GERDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1131 WEST ST, SOUTHINGTON, CT 06489-6006
(860) 621-7682
Mailing address
1131 WEST ST, SOUTHINGTON, CT 06489-6006
(860) 621-7682
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000428
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000428
CTCARE PROVIDER #
CT
01
—
217217
PREFERRED ONE
CT
Enumeration date
02/17/2006
Last updated
12/17/2012
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