Provider Demographics
NPI:1942688098
Name:GENEVRO, JULIANE
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:GENEVRO
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 1:3138 WAIALAE AVE
Mailing Address - Street 2:APARTMENT 428
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1535
Mailing Address - Country:US
Mailing Address - Phone:814-591-8033
Mailing Address - Fax:
Practice Address - Street 1:3138 WAIALAE AVE
Practice Address - Street 2:APARTMENT 428
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1535
Practice Address - Country:US
Practice Address - Phone:814-591-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-09
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer