Provider Demographics
NPI:1598126237
Name:FEWELL, GENEVIEVE MARNIE (RN)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:MARNIE
Last Name:FEWELL
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 1:518 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1606
Mailing Address - Country:US
Mailing Address - Phone:805-963-2445
Mailing Address - Fax:805-965-2292
Practice Address - Street 1:743 PISMO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3921
Practice Address - Country:US
Practice Address - Phone:888-898-3806
Practice Address - Fax:866-886-7824
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95077480163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse