Provider Demographics
NPI:1548538309
Name:GENSEL, JOAN M (RN)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:GENSEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:NY
Mailing Address - Zip Code:14871-9110
Mailing Address - Country:US
Mailing Address - Phone:607-735-3810
Mailing Address - Fax:
Practice Address - Street 1:1551 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:NY
Practice Address - Zip Code:14871-9110
Practice Address - Country:US
Practice Address - Phone:607-735-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242312-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program