Provider Demographics
NPI:1033893359
Name:KLEIN, GENEVIEVE (PMHNP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:STE 1500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2177
Practice Address - Country:US
Practice Address - Phone:602-824-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2023036307363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health