Provider Demographics
NPI:1811549728
Name:TADDESE, GENET (RN/BSN)
Entity Type:Individual
Prefix:MISS
First Name:GENET
Middle Name:
Last Name:TADDESE
Suffix:
Gender:F
Credentials:RN/BSN
Other - Prefix:MISS
Other - First Name:GENET
Other - Middle Name:
Other - Last Name:TADDESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN/BSN
Mailing Address - Street 1:8223 TWIN OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0611
Mailing Address - Country:US
Mailing Address - Phone:916-539-1767
Mailing Address - Fax:916-723-0138
Practice Address - Street 1:8223 TWIN OAKS AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0611
Practice Address - Country:US
Practice Address - Phone:916-539-1767
Practice Address - Fax:916-723-0138
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342700470310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility