Provider Demographics
NPI:1154682599
Name:FROST, GENOVA (RN)
Entity Type:Individual
Prefix:MRS
First Name:GENOVA
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16115 JUDSON DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2157
Mailing Address - Country:US
Mailing Address - Phone:216-990-0334
Mailing Address - Fax:
Practice Address - Street 1:16115 JUDSON DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2157
Practice Address - Country:US
Practice Address - Phone:216-990-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH247249163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse