Provider Demographics
NPI:1386436657
Name:GENOVESI, NICHOLLE DAWN
Entity type:Individual
Prefix:
First Name:NICHOLLE
Middle Name:DAWN
Last Name:GENOVESI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICHOLLE
Other - Middle Name:DAWN
Other - Last Name:STROBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6093 WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9242
Mailing Address - Country:US
Mailing Address - Phone:937-733-3394
Mailing Address - Fax:
Practice Address - Street 1:10400 BLACKLICK EASTERN RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8235
Practice Address - Country:US
Practice Address - Phone:937-621-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty