Provider Demographics
NPI:1720264823
Name:MCKIERNAN, GERALDINE THERESA ANNE (CFNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:THERESA ANNE
Last Name:MCKIERNAN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4412
Mailing Address - Country:US
Mailing Address - Phone:914-245-0292
Mailing Address - Fax:914-245-8499
Practice Address - Street 1:2000 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4412
Practice Address - Country:US
Practice Address - Phone:914-245-0292
Practice Address - Fax:914-245-8499
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331017-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily