Provider Demographics
NPI:1609396704
Name:GEORGIN, MARJORIE FRANCES (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:FRANCES
Last Name:GEORGIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:FRANCES
Other - Last Name:FREISTHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:1321 BELLEFONTAINE ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-8768
Practice Address - Country:US
Practice Address - Phone:567-356-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily