Provider Demographics
NPI:1376016196
Name:HORNER, GEORGIA ANN (RN BSN CDE)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:ANN
Last Name:HORNER
Suffix:
Gender:F
Credentials:RN BSN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3805A SPRING ST STE 311
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1600
Mailing Address - Country:US
Mailing Address - Phone:262-687-6345
Mailing Address - Fax:262-687-6344
Practice Address - Street 1:3805A SPRING ST STE 311
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1600
Practice Address - Country:US
Practice Address - Phone:262-687-6345
Practice Address - Fax:262-687-6344
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91360163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator