Provider Demographics
NPI:1346137031
Name:STULL, GENISA (RN, BSN, CNOR)
Entity type:Individual
Prefix:
First Name:GENISA
Middle Name:
Last Name:STULL
Suffix:
Gender:F
Credentials:RN, BSN, CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WALDEN RD APT 4
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3178
Mailing Address - Country:US
Mailing Address - Phone:925-964-6260
Mailing Address - Fax:
Practice Address - Street 1:675 YGNACIO VALLEY RD STE B101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3883
Practice Address - Country:US
Practice Address - Phone:925-964-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other