Provider Demographics
NPI:1821657966
Name:D'AMATO, GENEVIEVE GABRIELE
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:GABRIELE
Last Name:D'AMATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 RIVER PLACE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1119
Mailing Address - Country:US
Mailing Address - Phone:512-717-8391
Mailing Address - Fax:
Practice Address - Street 1:317 6TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4108
Practice Address - Country:US
Practice Address - Phone:515-864-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily