Healthcare Provider Details

I. General information

NPI: 1063772614
Provider Name (Legal Business Name): ANNA L GELOK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA L MINTON PA-C

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E PARKCENTER BLVD
BOISE ID
83706-6528
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-4210
  • Fax: 208-381-2045
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA157058
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2015
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: