Healthcare Provider Details

I. General information

NPI: 1902195498
Provider Name (Legal Business Name): LONNIE CHRISTOPHER GELLNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 FOUNTAIN VIEW DR STE. 200
HOUSTON TX
77057-4817
US

IV. Provider business mailing address

2411 FOUNTAIN VIEW DR STE. 200
HOUSTON TX
77057-4817
US

V. Phone/Fax

Practice location:
  • Phone: 713-620-4000
  • Fax:
Mailing address:
  • Phone: 713-620-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number717692
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: