Provider Demographics
NPI:1558302729
Name:GERMANO-YAW, GERALDINE ANN (NP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ANN
Last Name:GERMANO-YAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 BIG HILL RD
Mailing Address - Street 2:
Mailing Address - City:MORAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13118
Mailing Address - Country:US
Mailing Address - Phone:607-274-6230
Mailing Address - Fax:607-274-6316
Practice Address - Street 1:201 EAST GREEN ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-274-6230
Practice Address - Fax:607-274-6316
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3311701363L00000X
NYF4010451363LP0808X
NY3797211163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55750XMedicare ID - Type Unspecified
S15967Medicare UPIN