Provider Demographics
NPI:1700420775
Name:KINNEY, GENEVIEVE L (MACOM)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:L
Last Name:KINNEY
Suffix:
Gender:F
Credentials:MACOM
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:LAFOND
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACOM
Mailing Address - Street 1:340 ERICKSEN AVE NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1854
Mailing Address - Country:US
Mailing Address - Phone:206-201-9897
Mailing Address - Fax:
Practice Address - Street 1:340 ERICKSEN AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1854
Practice Address - Country:US
Practice Address - Phone:206-201-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-03
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAACUP.AC.60990154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist