Provider Demographics
NPI:1871835579
Name:PROTEAU, GENGI GUNN
Entity Type:Individual
Prefix:
First Name:GENGI
Middle Name:GUNN
Last Name:PROTEAU
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 1:23 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1680
Mailing Address - Country:US
Mailing Address - Phone:860-227-0173
Mailing Address - Fax:
Practice Address - Street 1:23 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:DEEP RIVER
Practice Address - State:CT
Practice Address - Zip Code:06417-1680
Practice Address - Country:US
Practice Address - Phone:860-227-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife