Provider Demographics
NPI:1730100538
Name:GENETTI, BEVERLEY J (RNFA)
Entity Type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:J
Last Name:GENETTI
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 POND ROAD
Mailing Address - Street 2:SUITE 101 LEHIGH VALLEY WOMENS CANCER CENTER
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2258
Mailing Address - Country:US
Mailing Address - Phone:610-366-8555
Mailing Address - Fax:610-366-8550
Practice Address - Street 1:1611 POND ROAD
Practice Address - Street 2:SUITE 101 LEHIGH VALLEY WOMENS CANCER CENTER
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2258
Practice Address - Country:US
Practice Address - Phone:610-366-8555
Practice Address - Fax:610-366-8550
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-296009L163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001718035-0004Medicaid
PA020640OtherMEDICARE ID UNSPECIFIED
G21688Medicare UPIN