Provider Demographics
NPI:1033870126
Name:SNOW, GJERTINE MAJ
Entity type:Individual
Prefix:
First Name:GJERTINE
Middle Name:MAJ
Last Name:SNOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GJERTINE
Other - Middle Name:MAJ
Other - Last Name:BAGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26975 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-7120
Mailing Address - Country:US
Mailing Address - Phone:218-731-9915
Mailing Address - Fax:
Practice Address - Street 1:3700 W DIVISION ST STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4031
Practice Address - Country:US
Practice Address - Phone:320-251-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-01
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN540411-07225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist