Provider Demographics
NPI:1760825954
Name:RAPHAEL, GERALDINE
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900B CLUBSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EAST BERNARD
Mailing Address - State:TX
Mailing Address - Zip Code:77435-8758
Mailing Address - Country:US
Mailing Address - Phone:832-744-8016
Mailing Address - Fax:346-241-0840
Practice Address - Street 1:900B CLUBSIDE DR
Practice Address - Street 2:
Practice Address - City:EAST BERNARD
Practice Address - State:TX
Practice Address - Zip Code:77435-8758
Practice Address - Country:US
Practice Address - Phone:281-903-7380
Practice Address - Fax:346-241-8040
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1028365163W00000X
TX020016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10293906OtherDRIVER LICENSE