Provider Demographics
NPI:1700538477
Name:EDMONDS, GEENA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:GEENA
Middle Name:MARIE
Last Name:EDMONDS
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 1:104 CHAUCER CT
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3200
Mailing Address - Country:US
Mailing Address - Phone:724-316-0049
Mailing Address - Fax:
Practice Address - Street 1:3428 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3132
Practice Address - Country:US
Practice Address - Phone:724-728-6670
Practice Address - Fax:724-728-5570
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant