Healthcare Provider Details

I. General information

NPI: 1023211638
Provider Name (Legal Business Name): AMY MARIE GEBERS CST, CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 MADISON CREEK DR
FORT COLLINS CO
80528-8516
US

IV. Provider business mailing address

5201 MADISON CREEK DR
FORT COLLINS CO
80528-8516
US

V. Phone/Fax

Practice location:
  • Phone: 970-225-1664
  • Fax:
Mailing address:
  • Phone: 970-225-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberCFA-104768
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: