Basic Information
Provider Information
NPI: 1558596478
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEIMER
FirstName: ANN
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 151
Address2:  
City: DECATUR
State: IN
PostalCode: 467330151
CountryCode: US
TelephoneNumber: 2607242145
FaxNumber: 2607283867
Practice Location
Address1: 1100 MERCER AVE
Address2:  
City: DECATUR
State: IN
PostalCode: 467332303
CountryCode: US
TelephoneNumber: 2607242145
FaxNumber: 2607283867
Other Information
ProviderEnumerationDate: 05/20/2009
LastUpdateDate: 05/20/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X71002922AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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