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General NPI Number Information
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NPI Number | 1659405686
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Entity Type | Individual
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Provider Name | GAIL R. GEORGE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 1451 FORE RD
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City | POCATELLO
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State | ID
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Zip | 83204-4300
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Country | US
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Telephone | 208-236-6360
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Fax |
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Provider Business Mailing Address
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Address Line | 2956 TRAIL CANYON RD
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City | SODA SPRINGS
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State | ID
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Zip | 83276-5216
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Country | US
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Telephone | 208-547-2369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 268A
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License Number State | ID
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