Individual
CONNIE MAE GENGELBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2411 FOUNTAIN VIEW DR, SUITE 200, HOUSTON, TX 77057-4817
(713) 458-4185
Mailing address
2411 FOUNTAIN VIEW DR, STE 200, HOUSTON, TX 77057-4817
(713) 620-4000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
023704
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088798604
—
TX
01
—
83197U
BLUE CROSS PROVIDER ID
TX
01
—
8B3529
MEDICARE OUT OF HARRISS
TX
01
—
P00004426
MEDICARE RAILROAD
TX
Enumeration date
01/10/2007
Last updated
02/11/2010
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