Provider Demographics
NPI:1649828062
Name:GEANON, CATHERINE TANOUE (PA-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:TANOUE
Last Name:GEANON
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 1:2510 SOLANA WAY UNIT 208
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6001
Mailing Address - Country:US
Mailing Address - Phone:414-737-6302
Mailing Address - Fax:
Practice Address - Street 1:209 E PAT RADY WAY
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105-5508
Practice Address - Country:US
Practice Address - Phone:765-301-7679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002764A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant