Provider Demographics
NPI:1528721701
Name:GERBER, JANICE BELLO
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:BELLO
Last Name:GERBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:G
Other - Last Name:BELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:560 S MAPLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1757
Mailing Address - Country:US
Mailing Address - Phone:612-845-2555
Mailing Address - Fax:
Practice Address - Street 1:560 S MAPLE ST STE 200
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1757
Practice Address - Country:US
Practice Address - Phone:612-845-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8993363LF0000X
MNF09211125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF09211125OtherNURSE PRACTITIONER LICENSE NUMBER