Provider Demographics
NPI:1366504060
Name:GERARD, MELINDA ANN
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:GERARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 E 115TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2622
Mailing Address - Country:US
Mailing Address - Phone:303-452-7103
Mailing Address - Fax:
Practice Address - Street 1:4031 E 115TH PL
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-2622
Practice Address - Country:US
Practice Address - Phone:303-452-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3340171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor