Provider Demographics
NPI:1235938515
Name:KILLEN, GENEVEIVE J
Entity type:Individual
Prefix:
First Name:GENEVEIVE
Middle Name:J
Last Name:KILLEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 AMBER VALLEY PKWY S APT 2
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8771
Mailing Address - Country:US
Mailing Address - Phone:701-638-2109
Mailing Address - Fax:
Practice Address - Street 1:5331 AMBER VALLEY PKWY S APT 2
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8771
Practice Address - Country:US
Practice Address - Phone:701-638-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant