Provider Demographics
NPI:1205167723
Name:BURKS-HEMINGWAY, GENESIS L (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:L
Last Name:BURKS-HEMINGWAY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:GENESIS
Other - Middle Name:L
Other - Last Name:BURKS-HEMINGWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:31 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3535
Mailing Address - Country:US
Mailing Address - Phone:845-565-4887
Mailing Address - Fax:
Practice Address - Street 1:31 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3535
Practice Address - Country:US
Practice Address - Phone:845-565-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3777391163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice