Basic Information
| Provider Information | |||||||||
| NPI: | 1619185394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PREUSS | ||||||||
| FirstName: | GEORGETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 TACOMA ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016053516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088521805 | ||||||||
| FaxNumber: | 5088538593 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 TACOMA ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016053516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088521805 | ||||||||
| FaxNumber: | 5088538593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 12/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN198633 | MA | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1301071 | 05 | MA | MEDICAID |