Provider Demographics
NPI:1669733192
Name:GEORGE, RITA IRIENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:IRIENE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JAGUAR DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813-9755
Mailing Address - Country:US
Mailing Address - Phone:585-268-7900
Mailing Address - Fax:585-268-7990
Practice Address - Street 1:1 JAGUAR DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9755
Practice Address - Country:US
Practice Address - Phone:585-268-7900
Practice Address - Fax:585-268-7990
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158202-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse