Provider Demographics
NPI:1851622542
Name:GEISLER, DEANNA LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:LYNN
Last Name:GEISLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 CEDAR BLUFF DR.
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9600
Mailing Address - Country:US
Mailing Address - Phone:231-487-2230
Mailing Address - Fax:231-487-6172
Practice Address - Street 1:4170 CEDAR BLUFF DR.
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9600
Practice Address - Country:US
Practice Address - Phone:231-487-2230
Practice Address - Fax:231-487-6172
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002137363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical