Provider Demographics
NPI:1194913582
Name:WIMBERLEY, GENEVIEVE LYNN (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:LYNN
Last Name:WIMBERLEY
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 N HOUK RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1043
Mailing Address - Country:US
Mailing Address - Phone:509-924-1990
Mailing Address - Fax:509-232-3059
Practice Address - Street 1:1415 N HOUK RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1043
Practice Address - Country:US
Practice Address - Phone:509-924-1990
Practice Address - Fax:509-232-3059
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant