Provider Demographics
NPI:1346025350
Name:GEORGE, EDWARD (CNP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7377 168TH CIR NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4385
Mailing Address - Country:US
Mailing Address - Phone:612-205-9877
Mailing Address - Fax:
Practice Address - Street 1:7377 168TH CIR NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4385
Practice Address - Country:US
Practice Address - Phone:612-205-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health