Provider Demographics
NPI:1972025492
Name:GENUS, PATRICIA (CERTIFIED)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:GENUS
Suffix:
Gender:F
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5692
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-0692
Mailing Address - Country:US
Mailing Address - Phone:319-338-1147
Mailing Address - Fax:319-338-1668
Practice Address - Street 1:875 22ND AVE
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1566
Practice Address - Country:US
Practice Address - Phone:319-338-1147
Practice Address - Fax:319-338-1668
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy