Provider Demographics
NPI:1831735315
Name:TOOKER, GENESIS IRIS (LPN)
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:IRIS
Last Name:TOOKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ALLEGHENY DR W
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2840
Mailing Address - Country:US
Mailing Address - Phone:631-855-6059
Mailing Address - Fax:
Practice Address - Street 1:16 ALLEGHENY DR W
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2840
Practice Address - Country:US
Practice Address - Phone:631-855-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse