Provider Demographics
NPI:1205161684
Name:DEGEORGE, MARY H (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:DEGEORGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:DEGEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:157 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2761
Mailing Address - Country:US
Mailing Address - Phone:985-537-6823
Mailing Address - Fax:
Practice Address - Street 1:157 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2761
Practice Address - Country:US
Practice Address - Phone:985-537-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN079419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN079419OtherSTATE OF LOUISIANA BOARD OF NURSING (RN)