Provider Demographics
NPI:1811794746
Name:MILLER, GENEVA LYNN (LVN 11)
Entity type:Individual
Prefix:MS
First Name:GENEVA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:
Credentials:LVN 11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19685 LAKE CALIFORNIA DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-7651
Mailing Address - Country:US
Mailing Address - Phone:707-496-2785
Mailing Address - Fax:
Practice Address - Street 1:818 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2759
Practice Address - Country:US
Practice Address - Phone:530-527-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240675167G00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty