Provider Demographics
NPI:1003939729
Name:GEORGE, BILLIE A (RN)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:A
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2313 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-7137
Mailing Address - Country:US
Mailing Address - Phone:208-467-5552
Mailing Address - Fax:
Practice Address - Street 1:2313 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-7137
Practice Address - Country:US
Practice Address - Phone:208-467-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-16147163WH0200X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806674100Medicaid