Provider Demographics
NPI:1215586953
Name:JAMES, GENEVA DELORSE (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:GENEVA
Middle Name:DELORSE
Last Name:JAMES
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-4034
Mailing Address - Country:US
Mailing Address - Phone:316-227-7779
Mailing Address - Fax:
Practice Address - Street 1:3920 MEADOW LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-4034
Practice Address - Country:US
Practice Address - Phone:316-227-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider