MEDICARE: GENEVIEVE L KINNEY MACOM

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	171100000X	Acupuncturist	ACUP.AC.60990154	WA

General Provider Information

NPI Number	:	1700420775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVIEVE L KINNEY MACOM

Provider Business Mailing Address
First Line	:	340 ERICKSEN AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1854
Country	:	US
Telephone Number	:	206-201-9897
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 ERICKSEN AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1854
Country	:	US
Telephone Number	:	206-201-9897
Fax Number	:

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

Provider Enumeration Date	:	11/03/2019
Last Update Date	:	12/04/2025

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