Provider Demographics
NPI:1982122800
Name:GENCO, RICHELLE ANTOYNETTE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:ANTOYNETTE
Last Name:GENCO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:JHOC OUTPATIENT
Practice Address - Street 2:601 NORTH CAROLINE , 6TH FLOOR, ROOM 6064
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-2195
Practice Address - Fax:443-287-4654
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily