Provider Demographics
NPI:1255843041
Name:ST-MARTIN, GENEVIEVE NICOLE CANNING (MS)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:NICOLE CANNING
Last Name:ST-MARTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4210
Mailing Address - Country:US
Mailing Address - Phone:253-403-2313
Mailing Address - Fax:
Practice Address - Street 1:1003 S 5TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4210
Practice Address - Country:US
Practice Address - Phone:253-403-1677
Practice Address - Fax:253-403-1676
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60802773170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60802773OtherGENETIC COUNSELOR PROVISIONAL LICENSE