Healthcare Provider Details

I. General information

NPI: 1831121201
Provider Name (Legal Business Name): ELIZABETH SAMUEL GEORGE MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 OLD YORK RD SUITE 204
ELKINS PARK PA
19027-1421
US

IV. Provider business mailing address

8614 COLONY DR
PHILADELPHIA PA
19152-2105
US

V. Phone/Fax

Practice location:
  • Phone: 215-635-3151
  • Fax:
Mailing address:
  • Phone: 215-934-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP008740
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: