Provider Demographics
NPI:1881831501
Name:TZENOV, GENEVA S (FNP-C)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:S
Last Name:TZENOV
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 MOX CHEHALIS RD
Mailing Address - Street 2:
Mailing Address - City:MCCLEARY
Mailing Address - State:WA
Mailing Address - Zip Code:98557-9408
Mailing Address - Country:US
Mailing Address - Phone:360-470-0671
Mailing Address - Fax:360-464-2617
Practice Address - Street 1:828 MOX CHEHALIS RD
Practice Address - Street 2:
Practice Address - City:MCCLEARY
Practice Address - State:WA
Practice Address - Zip Code:98557-9408
Practice Address - Country:US
Practice Address - Phone:360-470-0671
Practice Address - Fax:360-464-2617
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60046050363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner