Provider Demographics
NPI:1063869881
Name:GEISEL, BLAKEN
Entity type:Individual
Prefix:
First Name:BLAKEN
Middle Name:
Last Name:GEISEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-8300
Mailing Address - Country:US
Mailing Address - Phone:814-242-6171
Mailing Address - Fax:
Practice Address - Street 1:100 SUSAN DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2826
Practice Address - Country:US
Practice Address - Phone:814-255-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-22
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066487363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant