Provider Demographics
NPI:1063772614
Name:GELOK, ANNA L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:L
Last Name:GELOK
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:L
Other - Last Name:MINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E PARKCENTER BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6528
Practice Address - Country:US
Practice Address - Phone:208-381-4210
Practice Address - Fax:208-381-2045
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA157058363A00000X
IDPA-2015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant