Provider Demographics
NPI:1003807751
Name:PAUL, GEORGINA (FNP)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1111
Mailing Address - Country:US
Mailing Address - Phone:716-532-3368
Mailing Address - Fax:716-532-0074
Practice Address - Street 1:104 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1111
Practice Address - Country:US
Practice Address - Phone:716-532-3368
Practice Address - Fax:716-532-0074
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01499967Medicaid
NY11512GMedicare ID - Type Unspecified
NYR53957Medicare UPIN