Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN129040 | GA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | RN129040 | GA |
NPI | 1508993924 |
---|---|
Provider Name | Gena J Markwalter |
First Address | Augusta, GA 30914-3548 |
Second Address | Augusta, GA 30909-2205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/10/2018 |