Healthcare Provider Details

I. General information

NPI: 1972143196
Provider Name (Legal Business Name): ASLYN NICOLE GEORGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 HIGHWAY 10
JACKSON LA
70748-6238
US

IV. Provider business mailing address

PO BOX 395
CLINTON LA
70722-0395
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-1360
  • Fax: 225-683-1310
Mailing address:
  • Phone: 225-683-5292
  • Fax: 225-683-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN131077
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: