Healthcare Provider Details

I. General information

NPI: 1790233765
Provider Name (Legal Business Name): GENEVA NOELLE KENNEDY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GENEVA NOELLE KNUTH

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CARDINAL CT STE 240
SAN DIEGO CA
92123-3357
US

IV. Provider business mailing address

18 ROBERT ST APARTMENT 6
ROSLINDALE MA
02131-2539
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-9378
  • Fax: 858-277-9370
Mailing address:
  • Phone: 858-705-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2303029
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2303029
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95102883
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNPF95005449
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP95005449
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberN95005449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: