Provider Demographics
NPI:1811585664
Name:GELLER WEIGEL, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GELLER WEIGEL
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 1:508 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5920
Mailing Address - Country:US
Mailing Address - Phone:701-527-3926
Mailing Address - Fax:
Practice Address - Street 1:508 S 14TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5920
Practice Address - Country:US
Practice Address - Phone:701-527-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1454125Medicaid