Provider Demographics
NPI:1851794572
Name:LAMANCUSA, GENEVIEVE (FNP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:LAMANCUSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 ASH AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-3432
Mailing Address - Country:US
Mailing Address - Phone:720-771-2474
Mailing Address - Fax:
Practice Address - Street 1:3450 ASH AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3432
Practice Address - Country:US
Practice Address - Phone:720-771-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily