Individual
MRS. TAMMY MICHELLE GERDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1823 VT RTE 107, BETHEL, VT 05032-9107
(802) 234-9913
(802) 234-5507
Mailing address
PO BOX 182, BARNARD, VT 05031-0182
(802) 234-9913
(802) 234-5507
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0550030954
VT
363AM0700X
Medical Physician Assistant
Primary
0550030955
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010134
MEDICARE PTAN
VT
05
—
9000412
—
VT
Enumeration date
09/12/2006
Last updated
06/01/2010
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