Provider Demographics
NPI:1861892861
Name:STUBLER, GERALDINE JODY (APRN)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:JODY
Last Name:STUBLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 E 3900 S
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1474
Mailing Address - Country:US
Mailing Address - Phone:385-275-4673
Mailing Address - Fax:801-999-4166
Practice Address - Street 1:1345 E 3900 S
Practice Address - Street 2:SUITE 204
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1474
Practice Address - Country:US
Practice Address - Phone:385-275-4673
Practice Address - Fax:801-999-4166
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT223189-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily