Provider Demographics
NPI:1396493219
Name:GENOVA, HAILEY CHRISTYN (LVN)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:CHRISTYN
Last Name:GENOVA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 SPRINGWOOD ST APT C
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2749
Mailing Address - Country:US
Mailing Address - Phone:951-219-8032
Mailing Address - Fax:
Practice Address - Street 1:795 SPRINGWOOD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2749
Practice Address - Country:US
Practice Address - Phone:951-219-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA708745164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse