Healthcare Provider Details

I. General information

NPI: 1780401133
Provider Name (Legal Business Name): JESSICA MARIE GELLER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0037082
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: