Healthcare Provider Details

I. General information

NPI: 1851775506
Provider Name (Legal Business Name): PATRICIA ANNE GEISEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 LYNCREST AVE
NEW CITY NY
10956-4655
US

IV. Provider business mailing address

84 LYNCREST AVE
NEW CITY NY
10956-4655
US

V. Phone/Fax

Practice location:
  • Phone: 857-719-5055
  • Fax:
Mailing address:
  • Phone: 857-719-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number240990
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number240990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: