Healthcare Provider Details

I. General information

NPI: 1902021413
Provider Name (Legal Business Name): JENNIFER MARIE GELLER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE STE. 180
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 3199
GRAND JUNCTION CO
81502-3199
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-3633
  • Fax: 970-668-4406
Mailing address:
  • Phone: 970-241-0202
  • Fax: 970-245-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2396
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: