| Doctor Name: | MS. GWEN MARIE VERCHOTA |
| NPI Number: | 1073568861 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | MN30423 |
| Business Practice Address: | 1500 Birchmont Dr. Ne Bemidji State University, Student Center For Health Bemidji, MN - 566012699 |
| Business Phone Number: | 2187552053 |
| Business Fax Number: | |
| Mailing Address: | 51759 219th Ave, BEMIDJI |
| State: | MN |
| Postal Code: | 566019357 |
| Phone Number: | 2187551994 |
| Fax Number: | |
| NPI Enumeration Date: | 05/23/2006 |
| NPI Last Update Date: | 08/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | MN30423 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |