Provider Demographics
NPI:1316197478
Name:FOOTE, GEORGIA LEE (RN)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:LEE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:SD
Mailing Address - Zip Code:57752-0540
Mailing Address - Country:US
Mailing Address - Phone:605-455-2451
Mailing Address - Fax:
Practice Address - Street 1:1000 HEALTH CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:SD
Practice Address - Zip Code:57552
Practice Address - Country:US
Practice Address - Phone:605-455-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RN RO33215163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care