Provider Demographics
NPI:1922417120
Name:GEORGE, MEREDITH (FNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 MARTINIQUE LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-3625
Mailing Address - Country:US
Mailing Address - Phone:617-438-5692
Mailing Address - Fax:
Practice Address - Street 1:2791 AGOURA RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-3101
Practice Address - Country:US
Practice Address - Phone:617-438-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276997363LF0000X
CANP95006501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily