Provider Demographics
NPI:1083764476
Name:GEORGE, CEREE E (CNM)
Entity Type:Individual
Prefix:
First Name:CEREE
Middle Name:E
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CNM
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 SE NINTH STREET
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM-LONG PRAIRIE
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-1404
Mailing Address - Country:US
Mailing Address - Phone:320-732-2141
Mailing Address - Fax:320-732-6913
Practice Address - Street 1:20 SE NINTH STREET
Practice Address - Street 2:CENTRACARE HEALTH SYSTEM-LONG PRAIRIE
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1404
Practice Address - Country:US
Practice Address - Phone:320-732-2141
Practice Address - Fax:320-732-6913
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9200113367A00000X
MNR198464-6367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN420001010Medicare PIN