MEDICARE: LISA JEAN GEORGE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	713266	CA
2	163WH0200X	Home Health Registered Nurse	713266	CA
3	163WH1000X	Hospice Registered Nurse	713266	CA
4	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	713266	CA
5	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	713266	CA
6	163WP2201X	Ambulatory Care Registered Nurse	713266	CA

General Provider Information

NPI Number	:	1336444355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JEAN GEORGE RN

Provider Business Mailing Address
First Line	:	5050 ROSEVILLE RD SPC 617
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5138
Country	:	US
Telephone Number	:	916-968-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 ROSEVILLE RD SPC 617
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5138
Country	:	US
Telephone Number	:	916-968-3295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2011
Last Update Date	:	01/22/2011

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