MEDICARE: MRS. GERLYNDA DIANE GEISERT R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	99357	CO

General Provider Information

NPI Number	:	1043503782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GERLYNDA DIANE GEISERT R.N.

Provider Business Mailing Address
First Line	:	2525 S WADSWORTH BLVD STE 303
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3246
Country	:	US
Telephone Number	:	720-962-4555
Fax Number	:	303-716-7882

Provider Business Practice Location Address
First Line	:	2525 S WADSWORTH BLVD STE 303
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3246
Country	:	US
Telephone Number	:	720-962-4555
Fax Number	:	303-716-7882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	05/26/2011

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