Healthcare Provider Details

I. General information

NPI: 1316787674
Provider Name (Legal Business Name): GEORGINA GENUARIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 LAKEVIEW DR
PROVIDENCE RI
02910-1006
US

IV. Provider business mailing address

34 LAKEVIEW DR
PROVIDENCE RI
02910-1006
US

V. Phone/Fax

Practice location:
  • Phone: 508-405-5724
  • Fax:
Mailing address:
  • Phone: 508-405-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN52564
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN52564
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4265957
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: