Doctor Name: | MR. JON BURRILL GENO |
NPI Number: | 1093049827 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP-C |
License Number: | R34234 |
Business Practice Address: | 1050 W Perimeter Rd Andrews Afb, MD - 207626601 |
Business Phone Number: | 2408574530 |
Business Fax Number: | |
Mailing Address: | 1050 W Perimeter Rd, ANDREWS AFB |
State: | MD |
Postal Code: | 207626601 |
Phone Number: | 2408574530 |
Fax Number: | |
NPI Enumeration Date: | 09/26/2009 |
NPI Last Update Date: | 09/26/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R34234 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |