Provider Demographics
NPI:1891344362
Name:IENCO, GENOVEVA
Entity Type:Individual
Prefix:MRS
First Name:GENOVEVA
Middle Name:
Last Name:IENCO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GENOVEVA
Other - Middle Name:
Other - Last Name:GOMEZ-IRAHETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 GARRISONVILLE RD
Mailing Address - Street 2:P.O. BOX 151
Mailing Address - City:GARRISONVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22463
Mailing Address - Country:US
Mailing Address - Phone:703-899-8997
Mailing Address - Fax:
Practice Address - Street 1:3 CROSSWOOD PL
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7839
Practice Address - Country:US
Practice Address - Phone:703-899-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401181239376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide