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General NPI Number Information
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NPI Number | 1508656752
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Entity Type | Individual
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Provider Name | GENEVA LYNN MCCLOUD MPH
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Gender | Female
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Dates
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Enumeration Date | 05/10/2025
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 989 UNIVERSITY DR STE 101
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City | PONTIAC
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State | MI
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Zip | 48342-1885
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Country | US
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Telephone | 248-334-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 2785 E GRAND BLVD UNIT 462
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City | DETROIT
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State | MI
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Zip | 48211-2003
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Country | US
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Telephone | 313-354-5014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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