Provider Demographics
NPI:1073203857
Name:GEORGE, WREN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:WREN
Middle Name:MARIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:172 HARVEY OSTEEN RD
Mailing Address - Street 2:
Mailing Address - City:ZIRCONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28790-5701
Mailing Address - Country:US
Mailing Address - Phone:317-362-8009
Mailing Address - Fax:
Practice Address - Street 1:1027 FLEMING ST STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3534
Practice Address - Country:US
Practice Address - Phone:828-435-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant