Provider Demographics
NPI:1336444355
Name:GEORGE, LISA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 ROSEVILLE RD SPC 617
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5138
Mailing Address - Country:US
Mailing Address - Phone:916-968-3295
Mailing Address - Fax:
Practice Address - Street 1:5050 ROSEVILLE RD SPC 617
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5138
Practice Address - Country:US
Practice Address - Phone:916-968-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713266163W00000X, 163WH0200X, 163WH1000X, 163WP0807X, 163WP0809X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care