Healthcare Provider Details

I. General information

NPI: 1720913122
Provider Name (Legal Business Name): AMY-BETH ST.GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ALPINE DR
WEST BOYLSTON MA
01583-2311
US

IV. Provider business mailing address

2 ALPINE DR
WEST BOYLSTON MA
01583-2311
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-8585
  • Fax: 508-334-4799
Mailing address:
  • Phone: 508-334-8585
  • Fax: 508-334-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number53099
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: