Provider Demographics
NPI:1679059489
Name:MUTHAMI, GEOFFREY MUTISYA (CRNP)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:MUTISYA
Last Name:MUTHAMI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10498 MAPLETON RD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9026
Mailing Address - Country:US
Mailing Address - Phone:717-729-0806
Mailing Address - Fax:
Practice Address - Street 1:10498 MAPLETON RD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9026
Practice Address - Country:US
Practice Address - Phone:717-729-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily