Provider Demographics
NPI:1093146953
Name:GEORGE, SHEEBA
Entity Type:Individual
Prefix:
First Name:SHEEBA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N VALLEY PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-353-8616
Mailing Address - Fax:972-353-5352
Practice Address - Street 1:502 N VALLEY PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-353-8616
Practice Address - Fax:972-353-5352
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736546363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX736546OtherANP-C LICENSE