Provider Demographics
NPI:1215104013
Name:PENTINIO, GERALDINE TATOY (PT)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:TATOY
Last Name:PENTINIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 WATERSIDE ST
Mailing Address - Street 2:APT 208
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9224 WATERSIDE ST
Practice Address - Street 2:APT 208
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5023
Practice Address - Country:US
Practice Address - Phone:608-443-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility