Provider Demographics
NPI:1942956545
Name:GEORGE, NACHYA AILEEN
Entity Type:Individual
Prefix:MS
First Name:NACHYA
Middle Name:AILEEN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 1/2 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1525
Mailing Address - Country:US
Mailing Address - Phone:150-931-0979
Mailing Address - Fax:509-865-2064
Practice Address - Street 1:16 1/2 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1525
Practice Address - Country:US
Practice Address - Phone:150-931-0979
Practice Address - Fax:509-865-2064
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional