Healthcare Provider Details

I. General information

NPI: 1992546121
Provider Name (Legal Business Name): GENEPSYCHE NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 E COOLEY DR
COLTON CA
92324-3901
US

IV. Provider business mailing address

1007 E COOLEY DR
COLTON CA
92324-3901
US

V. Phone/Fax

Practice location:
  • Phone: 909-730-9581
  • Fax:
Mailing address:
  • Phone: 909-730-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHEAL ANEKE
Title or Position: CEO
Credential:
Phone: 909-730-9581