Provider Demographics
NPI:1396891826
Name:FANOUS, GEORGENE A (CNP)
Entity type:Individual
Prefix:
First Name:GEORGENE
Middle Name:A
Last Name:FANOUS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 BELMERE DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5102
Mailing Address - Country:US
Mailing Address - Phone:440-885-5623
Mailing Address - Fax:
Practice Address - Street 1:850 BRAINARD ROAD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS.
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-995-4500
Practice Address - Fax:440-995-4585
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP-06103OtherCERTIFIED NURSE PRACTITIO