Provider Demographics
NPI:1316310816
Name:CLOSE, GEENA
Entity type:Individual
Prefix:
First Name:GEENA
Middle Name:
Last Name:CLOSE
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 1:2061 CLOVER MILL RD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2142
Mailing Address - Country:US
Mailing Address - Phone:267-424-4776
Mailing Address - Fax:
Practice Address - Street 1:2061 CLOVER MILL RD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2142
Practice Address - Country:US
Practice Address - Phone:267-424-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
58139OtherSTUDENT