Healthcare Provider Details

I. General information

NPI: 1003009952
Provider Name (Legal Business Name): MARY COLEEN GELMANN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLEEN GELMANN CRNA

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21A OAK BRANCH DR
GREENSBORO NC
27407-2145
US

IV. Provider business mailing address

21A OAK BRANCH DR
GREENSBORO NC
27407-2145
US

V. Phone/Fax

Practice location:
  • Phone: 336-478-2664
  • Fax:
Mailing address:
  • Phone: 336-478-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041887
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7039
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: