Provider Demographics
NPI:1437658473
Name:GEORGE, KATRINA AUBRIEANA (MSN, CNM, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:AUBRIEANA
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MSN, CNM, IBCLC
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-372-4000
Mailing Address - Fax:704-334-4855
Practice Address - Street 1:1718 E 4TH ST STE 907
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3282
Practice Address - Country:US
Practice Address - Phone:704-372-4000
Practice Address - Fax:704-334-4855
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
NC677367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife