Provider Demographics
NPI:1245353309
Name:GEORGES, MARIE THERESE (FNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESE
Last Name:GEORGES
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:31588 RAILROAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9468
Mailing Address - Country:US
Mailing Address - Phone:951-291-2065
Mailing Address - Fax:951-471-8026
Practice Address - Street 1:107 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6561
Practice Address - Country:US
Practice Address - Phone:951-358-0141
Practice Address - Fax:877-778-8365
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2019-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71005381A363LF0000X
MDR135819363LF0000X
MI4704287858363LF0000X
CA18678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily