Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP024986 | PA |
NPI | 1023778032 |
---|---|
Provider Name | Geraldine Anamege |
First Address | Stroudsburg, PA 18360-2110 |
Second Address | Stroudsburg, PA 18360-2110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2021 |
Last Update Date | 19/12/2021 |