Healthcare Provider Details

I. General information

NPI: 1982246047
Provider Name (Legal Business Name): GESSNER PETERSON HOUSE CALLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E 400 N # 316
LOGAN UT
84321-4020
US

IV. Provider business mailing address

41 E 400 N # 316
LOGAN UT
84321-4020
US

V. Phone/Fax

Practice location:
  • Phone: 801-577-8678
  • Fax: 801-206-7736
Mailing address:
  • Phone: 801-577-8678
  • Fax: 801-206-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARY GESSNER-PETERSON
Title or Position: PRESIDENT
Credential:
Phone: 215-778-5011