Provider Demographics
NPI:1699929927
Name:JANUARY, GERALDINE R (RN, PMHCNS)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:R
Last Name:JANUARY
Suffix:
Gender:F
Credentials:RN, PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:RADIUM SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:88054-0168
Mailing Address - Country:US
Mailing Address - Phone:575-202-0344
Mailing Address - Fax:
Practice Address - Street 1:1990 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-526-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR58219163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult