Provider Demographics
NPI:1336241249
Name:GEORGE, PHYLLIS (RN, MA, FNP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RN, MA, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6707
Mailing Address - Country:US
Mailing Address - Phone:845-452-2120
Mailing Address - Fax:845-452-2104
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6707
Practice Address - Country:US
Practice Address - Phone:845-452-2120
Practice Address - Fax:845-452-2104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189398208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery