Provider Demographics
NPI:1376629204
Name:GEILING, FAIRY (RN)
Entity Type:Individual
Prefix:
First Name:FAIRY
Middle Name:
Last Name:GEILING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:IN
Mailing Address - Zip Code:47042-0766
Mailing Address - Country:US
Mailing Address - Phone:812-689-6363
Mailing Address - Fax:
Practice Address - Street 1:202 N GASLIGHT DRIVE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042
Practice Address - Country:US
Practice Address - Phone:812-689-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28056680A171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator