Provider Demographics
NPI:1205263696
Name:HUBER, GEENA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:GEENA
Middle Name:MARIE
Last Name:HUBER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-1322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2350 ROUTE 63
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9509
Practice Address - Country:US
Practice Address - Phone:585-728-3006
Practice Address - Fax:585-728-3446
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310725164W00000X
NY702567163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161039939Medicaid
NY161039939OtherALL OTHER INSURANCES