MEDICARE: GENYSISNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1841021813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENYSISNP

Provider Business Mailing Address
First Line	:	5720 CREEDMOOR RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2382
Country	:	US
Telephone Number	:	919-322-9246
Fax Number	:

Provider Business Practice Location Address
First Line	:	5720 CREEDMOOR RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2382
Country	:	US
Telephone Number	:	919-322-9246
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. DONNA NICOLE ANDERSON
Credential	:	NP
Telephone Number	:	919-322-9246

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/13/2024

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