Provider Demographics
NPI:1255340717
Name:GEISERT, JORJE JETTE
Entity type:Individual
Prefix:DR
First Name:JORJE
Middle Name:JETTE
Last Name:GEISERT
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-0310
Mailing Address - Country:US
Mailing Address - Phone:308-352-4511
Mailing Address - Fax:308-352-2278
Practice Address - Street 1:218 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:NE
Practice Address - Zip Code:69140-3016
Practice Address - Country:US
Practice Address - Phone:308-352-4511
Practice Address - Fax:308-352-2278
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470624653-00Medicaid