Healthcare Provider Details

I. General information

NPI: 1346661915
Provider Name (Legal Business Name): AMY GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

7A WYNWOOD DR
PEMBERTON NJ
08068-9703
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR10192500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: