Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 36635 | KY |
Y | 207Q00000X | Family Doctor | 36635 | KY |
NPI | 1063421030 |
---|---|
Provider Name | Giovannie C Eugenio |
First Address | Somerset, KY 42502 |
Second Address | Somerset, KY 42501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64036700 | (05) | KY |
H44343 | (02) |