Healthcare Provider Details

I. General information

NPI: 1740839257
Provider Name (Legal Business Name): MISS GENEVIEVE R CANETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W D.L. INGRAM AVENUE BLDG 1408
CANNON AFB NM
88103
US

IV. Provider business mailing address

224 W D. L. INGRAM AVENUE BLDG 1408
CANNON AFB NM
88103
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number181676
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number181676
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number33861
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number181676
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNURR33861
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: