Healthcare Provider Details

I. General information

NPI: 1235966367
Provider Name (Legal Business Name): MRS. GENEVA MARIE NEVILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17440 HENDERSON PASS
SAN ANTONIO TX
78232-1662
US

IV. Provider business mailing address

369 MISTY SAILS
CIBOLO TX
78108-0078
US

V. Phone/Fax

Practice location:
  • Phone: 210-483-5957
  • Fax:
Mailing address:
  • Phone: 619-750-4781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1044575
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: