Provider Demographics
NPI:1184168155
Name:GENNA, ALICIA (FNP, LAC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GENNA
Suffix:
Gender:F
Credentials:FNP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 N 8TH ST
Mailing Address - Street 2:APARTMENT 3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 GREENPOINT AVE
Practice Address - Street 2:SUITE A2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1545
Practice Address - Country:US
Practice Address - Phone:718-218-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005822-1171100000X
NY349871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171100000XOther Service ProvidersAcupuncturist