Provider Demographics
NPI:1952340762
Name:SMITH, GENEVA GERTRUDE (ACNP)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:GERTRUDE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:GENEVA
Other - Middle Name:GERTRUDE
Other - Last Name:BILDERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3008 N DOBSON RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1295
Mailing Address - Country:US
Mailing Address - Phone:480-496-2699
Mailing Address - Fax:
Practice Address - Street 1:16222 N 59TH AVE
Practice Address - Street 2:SUITE A100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1701
Practice Address - Country:US
Practice Address - Phone:623-334-4000
Practice Address - Fax:623-334-4400
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN132657163W00000X
TX681651363LA2100X
AZAP2132363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
8Y9072OtherBCBS
TX199155601Medicaid
TX199155602Medicaid
TX199155601Medicaid
TX8L11628Medicare PIN