Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00296100 | NJ |
NPI | 1013221308 |
---|---|
Provider Name | Mrs. Lalaine Genuino |
First Address | Monroe Township, NJ 08831-4035 |
Second Address | Toms River, NJ 08753-6699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2010 |
Last Update Date | 22/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0238121 | (05) | NJ |
P01140704 | RAILROAD MEDICARE (01) | NJ |