Provider Demographics
NPI:1144390295
Name:GERACI, EILEEN PATRICIA (APRN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:PATRICIA
Last Name:GERACI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MAIN ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4946
Mailing Address - Country:US
Mailing Address - Phone:203-378-3080
Mailing Address - Fax:203-377-3897
Practice Address - Street 1:2900 MAIN ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4946
Practice Address - Country:US
Practice Address - Phone:203-378-3080
Practice Address - Fax:203-377-3897
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2272363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ19615Medicare UPIN
CT500001290Medicare ID - Type Unspecified