Individual
JACQUELINE GERRISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 S WASILLA ST UNIT 26, WASILLA, AK 99654-8173
(907) 982-5039
Mailing address
401 S WASILLA ST UNIT 26, WASILLA, AK 99654-8173
(907) 982-5039
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
111149
AL
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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