MEDICARE: MRS. JOAN M GENSEL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	242312-1	NY

General Provider Information

NPI Number	:	1548538309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN M GENSEL RN

Provider Business Mailing Address
First Line	:	1551 PENNSYLVANIA AVE
Second Line	:
City	:	PINE CITY
State	:	NY
Zip	:	14871-9110
Country	:	US
Telephone Number	:	607-735-3810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 PENNSYLVANIA AVE
Second Line	:
City	:	PINE CITY
State	:	NY
Zip	:	14871-9110
Country	:	US
Telephone Number	:	607-735-3810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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