Provider Demographics
NPI:1568061042
Name:GEORGE, RACHEAL (LPN)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13603 BARNET LN APT 32
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3466
Mailing Address - Country:US
Mailing Address - Phone:415-845-1392
Mailing Address - Fax:
Practice Address - Street 1:4627 CLAY ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4663
Practice Address - Country:US
Practice Address - Phone:415-845-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1007779164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse