Provider Demographics
NPI:1649270463
Name:WASIL-RAYMOND, GENEVIEVE (CRNP)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:WASIL-RAYMOND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8344
Practice Address - Street 1:225 KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1214
Practice Address - Country:US
Practice Address - Phone:814-886-4635
Practice Address - Fax:814-886-5470
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004208B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S60674Medicare UPIN
PA013040Medicare ID - Type Unspecified