Provider Demographics
NPI:1467423285
Name:MALAGISE, GERMAINE C (CRNP)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:C
Last Name:MALAGISE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1919
Mailing Address - Country:US
Mailing Address - Phone:724-774-0778
Mailing Address - Fax:724-774-1109
Practice Address - Street 1:605 SHARON RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1919
Practice Address - Country:US
Practice Address - Phone:724-774-0778
Practice Address - Fax:724-774-1109
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004353M363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS59376Medicare UPIN
PA008618Medicare ID - Type Unspecified