Provider Demographics
NPI:1275123564
Name:FIELDS, GEORGENE LOUISE
Entity Type:Individual
Prefix:MS
First Name:GEORGENE
Middle Name:LOUISE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GEORGENE
Other - Middle Name:LOUISE
Other - Last Name:GACKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7027 STATE RD APT 206
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4968
Mailing Address - Country:US
Mailing Address - Phone:440-533-8216
Mailing Address - Fax:
Practice Address - Street 1:801 E WASHINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3336
Practice Address - Country:US
Practice Address - Phone:330-722-1069
Practice Address - Fax:330-764-9712
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator