Provider Demographics
NPI:1396956132
Name:WALMSLEY, GERALDINE RAE (PT)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:RAE
Last Name:WALMSLEY
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:HC 81 BOX 362B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-9570
Mailing Address - Country:US
Mailing Address - Phone:505-425-1969
Mailing Address - Fax:
Practice Address - Street 1:HC 81 BOX 362B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9570
Practice Address - Country:US
Practice Address - Phone:505-425-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMP.T. 345171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM345OtherP.T. LICENSE