Organization
HEARTHSTONE DERMATOLOGY NONPROFIT PROFESSIONAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENEVA TZENOV FNP-C (CEO-ADMINISTRATOR)
(360) 470-0671
Entity
Organization
Contact information
Practice address
828 MOX CHEHALIS RD, MCCLEARY, WA 98557-9408
(360) 470-0671
(360) 464-2617
Mailing address
828 MOX CHEHALIS RD, MCCLEARY, WA 98557-9408
(360) 470-0671
(360) 464-2617
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2012498
—
WA
Enumeration date
09/22/2020
Last updated
09/22/2020
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