Provider Demographics
NPI:1235384215
Name:GEONZON-GONZALES, MARIBEN RESTON (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIBEN
Middle Name:RESTON
Last Name:GEONZON-GONZALES
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2404
Mailing Address - Country:US
Mailing Address - Phone:484-461-9708
Mailing Address - Fax:
Practice Address - Street 1:8151 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2910
Practice Address - Country:US
Practice Address - Phone:215-685-6988
Practice Address - Fax:215-685-7081
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009504363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care