Individual
MYLENE GERONIMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
203088
CT
363LP0200X
Pediatric Nurse Practitioner
Primary
17034
CT
Other
Enumeration date
03/06/2025
Last updated
05/07/2026
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