Healthcare Provider Details

I. General information

NPI: 1447735048
Provider Name (Legal Business Name): GENEVIEVE PURCELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 12/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 PACHECO ST
CONCORD CA
94520-2309
US

IV. Provider business mailing address

2185 PACHECO ST
CONCORD CA
94520-2309
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-0505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95107287
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95010499
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: