Healthcare Provider Details

I. General information

NPI: 1679891105
Provider Name (Legal Business Name): MONET JEANETTE GEDZAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 KEYSTONE RD
CHESTER PA
19013-1723
US

IV. Provider business mailing address

923 KEYSTONE RD
CHESTER PA
19013-1723
US

V. Phone/Fax

Practice location:
  • Phone: 814-792-9670
  • Fax:
Mailing address:
  • Phone: 814-792-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN669483
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: