Healthcare Provider Details

I. General information

NPI: 1154380657
Provider Name (Legal Business Name): LINDA A GELLERMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 WOODWINDS DR
WOODBURY MN
55125-2298
US

IV. Provider business mailing address

102 CIMARRON CIR
APPLE VALLEY MN
55124-9721
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-0655
  • Fax: 651-232-6711
Mailing address:
  • Phone: 612-867-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR061758-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: