Provider Demographics
NPI:1740633288
Name:GEITER, MARK (LPN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GEITER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 FIELDSTON TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2232
Mailing Address - Country:US
Mailing Address - Phone:585-520-2201
Mailing Address - Fax:
Practice Address - Street 1:91 FIELDSTON TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-2232
Practice Address - Country:US
Practice Address - Phone:585-520-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325757164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse