Healthcare Provider Details

I. General information

NPI: 1225976475
Provider Name (Legal Business Name): MARCELLA R GANNON APN, NP-RX, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 17TH ST # 898
DENVER CO
80202-1508
US

IV. Provider business mailing address

1312 17TH ST # 898
DENVER CO
80202-1508
US

V. Phone/Fax

Practice location:
  • Phone: 970-638-7775
  • Fax:
Mailing address:
  • Phone: 970-638-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0175321
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1002066.NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: