Provider Demographics
NPI:1689462640
Name:PROVO, GENIE SABAS
Entity type:Individual
Prefix:
First Name:GENIE
Middle Name:SABAS
Last Name:PROVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GENIE
Other - Middle Name:JONTILLA
Other - Last Name:SABAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1907
Mailing Address - Country:US
Mailing Address - Phone:907-745-2634
Mailing Address - Fax:907-745-4897
Practice Address - Street 1:11921 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8833
Practice Address - Country:US
Practice Address - Phone:907-745-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist