Healthcare Provider Details

I. General information

NPI: 1881831501
Provider Name (Legal Business Name): GENEVA S TZENOV FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 MOX CHEHALIS RD
MCCLEARY WA
98557-9408
US

IV. Provider business mailing address

828 MOX CHEHALIS RD
MCCLEARY WA
98557-9408
US

V. Phone/Fax

Practice location:
  • Phone: 360-470-0671
  • Fax: 360-464-2617
Mailing address:
  • Phone: 360-470-0671
  • Fax: 360-464-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60046050
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60046050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: