Provider Demographics
NPI:1598204125
Name:GEOWAY LLC
Entity Type:Organization
Organization Name:GEOWAY LLC
Other - Org Name:A NEW CREATION CLINIC AND MEDI-SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:520-293-1117
Mailing Address - Street 1:1801 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1277
Mailing Address - Country:US
Mailing Address - Phone:520-293-1117
Mailing Address - Fax:520-293-7701
Practice Address - Street 1:1801 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1277
Practice Address - Country:US
Practice Address - Phone:520-293-1117
Practice Address - Fax:520-293-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty