Healthcare Provider Details

I. General information

NPI: 1023551223
Provider Name (Legal Business Name): HOLLY V GELBERT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY V JACKSON

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WILSON BLVD FL 6
ARLINGTON VA
22209-2281
US

IV. Provider business mailing address

1101 WILSON BLVD FL 6
ARLINGTON VA
22209-2281
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0992736-CNM
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11003757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: