Provider Demographics
NPI:1215658364
Name:PAULYCARPE, GEORGETTE (CNM)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:
Last Name:PAULYCARPE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 1ST ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2546
Mailing Address - Country:US
Mailing Address - Phone:917-405-9710
Mailing Address - Fax:
Practice Address - Street 1:437 1ST ST APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2546
Practice Address - Country:US
Practice Address - Phone:917-405-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002166367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife