Provider Demographics
NPI:1871651323
Name:COLVIN, GENISE MARIE
Entity Type:Individual
Prefix:MS
First Name:GENISE
Middle Name:MARIE
Last Name:COLVIN
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 1:496 W THORNTON STREET
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307
Mailing Address - Country:US
Mailing Address - Phone:330-535-8048
Mailing Address - Fax:
Practice Address - Street 1:496 W THORNTON STREET
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307
Practice Address - Country:US
Practice Address - Phone:330-535-8048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
2406944Medicare UPIN