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NPI 1639068299

NPI 1639068299 : ELISHA GENGOZIAN : SIDNEY, NE

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General NPI Number Information
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    NPI Number           |    1639068299
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    Entity Type          |    Individual 
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    Provider Name        |    ELISHA GENGOZIAN
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    06/30/2025
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    Last Update Date     |    06/30/2025
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Provider Practice Location Address
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    Address Line         |    1037 QUINCE ST 
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    City                 |    SIDNEY
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    State                |    NE
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    Zip                  |    69162-2247
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    Country              |    US
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    Telephone            |    308-760-4138
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1037 QUINCE ST 
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    City                 |    SIDNEY
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    State                |    NE
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    Zip                  |    69162-2247
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    Country              |    US
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    Telephone            |    308-760-4138
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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        |    374U00000X
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    Taxonomy Name        |    Home Health Aide
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    License Number       |    
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    License Number State |    
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