Healthcare Provider Details

I. General information

NPI: 1841012002
Provider Name (Legal Business Name): CAITLYN GELLER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 W BASELINE RD
LAVEEN AZ
85339-1801
US

IV. Provider business mailing address

11853 N 154TH DR
SURPRISE AZ
85379-6339
US

V. Phone/Fax

Practice location:
  • Phone: 602-764-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number294087
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: