MEDICARE: DR. NICOLE S. CHRISTIAN-GENIUS CNM, DM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	R152087	MD
2	367A00000X	Advanced Practice Midwife	NMW236250	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629370382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE S. CHRISTIAN-GENIUS CNM, DM

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	818-658-5980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 VERDUGO BLVD STE 413
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1468
Country	:	US
Telephone Number	:	818-658-5980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	09/15/2023

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