Provider Demographics
NPI:1073123501
Name:SWEENEY, GENEVIEVE ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ELIZABETH
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 SILVER PKWY APT 208
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3479
Mailing Address - Country:US
Mailing Address - Phone:616-427-5066
Mailing Address - Fax:
Practice Address - Street 1:4870 W CLARK RD STE 100
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1104
Practice Address - Country:US
Practice Address - Phone:734-725-8802
Practice Address - Fax:734-480-8686
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313968363LG0600X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care