MEDICARE: LAUREL FITZHENRY GEORGE CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	NA08453117	TX

General Provider Information

NPI Number	:	1013107424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL FITZHENRY GEORGE CNA

Provider Business Mailing Address
First Line	:	PO BOX 318
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77305-0318
Country	:	US
Telephone Number	:	713-582-2459
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 HI LO LN
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-1539
Country	:	US
Telephone Number	:	713-582-2459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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