Provider Demographics
NPI:1619130861
Name:GELLER, LORI M (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:M
Last Name:GELLER
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:2606 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3706
Mailing Address - Country:US
Mailing Address - Phone:612-545-5311
Mailing Address - Fax:612-224-9622
Practice Address - Street 1:624 SMITH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2620
Practice Address - Country:US
Practice Address - Phone:651-689-3988
Practice Address - Fax:612-224-9622
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12736367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1619130861OtherPROVIDER NPI
MNMG1798935OtherDEA