Healthcare Provider Details

I. General information

NPI: 1477043339
Provider Name (Legal Business Name): GERALDINE MCGOWAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 WASHINGTON ST. 2ND FLOOR PROS DEPARTMENT
MOUNT VERNON NY
10553
US

IV. Provider business mailing address

256 WASHINGTON ST 2ND FLOOR PROS DEPARTMENT
MOUNT VERNON NY
10553
US

V. Phone/Fax

Practice location:
  • Phone: 914-613-0700
  • Fax:
Mailing address:
  • Phone: 914-613-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number177984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: