Provider Demographics
NPI:1861729485
Name:MUTH-MAURELLI, GEORGINA D (APN)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:D
Last Name:MUTH-MAURELLI
Suffix:
Gender:F
Credentials:APN
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 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-4321
Mailing Address - Country:US
Mailing Address - Phone:908-675-6290
Mailing Address - Fax:
Practice Address - Street 1:MUSC & SCDC MEDICAL ANNEX @ KIRKLAND CORRECTIONAL FACIL
Practice Address - Street 2:4344 BROAD RIVER ROAD
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:908-675-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.27914363LF0000X
NJ26NJ00259000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner