Individual
NATHANIEL GEORGETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
330 HOLLY HILL LN, SOUTHBURY, CT 06488-4685
(203) 910-0556
Mailing address
111 CLOCK TOWER COMMONS, ROUTE 22, BREWSTER, NY 10509-4055
(845) 592-4915
(845) 279-5168
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
65314
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65314
LICENSE
CT
01
—
P00350616
RAILROAD MEDICARE
CT
Enumeration date
08/05/2006
Last updated
08/07/2015
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