Healthcare Provider Details

I. General information

NPI: 1811585664
Provider Name (Legal Business Name): GINA GELLER WEIGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S 14TH ST
BISMARCK ND
58504-5920
US

IV. Provider business mailing address

508 S 14TH ST
BISMARCK ND
58504-5920
US

V. Phone/Fax

Practice location:
  • Phone: 701-527-3926
  • Fax:
Mailing address:
  • Phone: 701-527-3926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: