Provider Demographics
NPI:1003009952
Name:GELMANN, MARY COLEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:COLEEN
Last Name:GELMANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:
Other - Last Name:GELMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:21A OAK BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2145
Mailing Address - Country:US
Mailing Address - Phone:336-478-2664
Mailing Address - Fax:
Practice Address - Street 1:21A OAK BRANCH DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2145
Practice Address - Country:US
Practice Address - Phone:336-478-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD041887367500000X
NC7039367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
041887OtherCRNA NUMBER
041887OtherCRNA NUMBER