Provider Demographics
NPI:1891142758
Name:GEORGE, ASHA (APN)
Entity Type:Individual
Prefix:MS
First Name:ASHA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 QUINCY BRIDGE LN
Mailing Address - Street 2:APT 302
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5610
Mailing Address - Country:US
Mailing Address - Phone:630-670-7602
Mailing Address - Fax:
Practice Address - Street 1:668 QUINCY BRIDGE LANE
Practice Address - Street 2:APT 302
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5610
Practice Address - Country:US
Practice Address - Phone:630-670-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily