Basic Information
| Provider Information | |||||||||
| NPI: | 1043408826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEISINGER CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
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| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178223034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702715555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 166 HANOVER ST | ||||||||
| Address2: | STE 203 | ||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708258780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2007 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | MULL | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SYSTEM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5702716603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | OS009287L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.