Provider Demographics
NPI:1861701666
Name:GERAGHTY, KRISTEN MARIE (RN, NP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:UCLA MEDL CNTR ONCOLOGY CNTR BOWYER CLINIC
Mailing Address - Street 2:BOX 956956, STE 120, 200 MEDL PLZ
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-6956
Mailing Address - Country:US
Mailing Address - Phone:858-449-8761
Mailing Address - Fax:
Practice Address - Street 1:UCLA MEDL CNTR ONCOLOGY CNTR BOWYER CLINIC
Practice Address - Street 2:BOX 956956, STE 120, 200 MEDL PLZ
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6956
Practice Address - Country:US
Practice Address - Phone:858-449-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner