Provider Demographics
NPI:1336987213
Name:GENGENBACH, SOPHIE ANN
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ANN
Last Name:GENGENBACH
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 1:5400 W 97TH AVE APT 2208
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5721
Mailing Address - Country:US
Mailing Address - Phone:402-840-3202
Mailing Address - Fax:
Practice Address - Street 1:5400 W 97TH AVE APT 2208
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-5721
Practice Address - Country:US
Practice Address - Phone:402-840-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant