Provider Demographics
NPI:1740057231
Name:GEORGE, KENDRICK CONNVIEL (CNA)
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:CONNVIEL
Last Name:GEORGE
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:KENDRICK
Other - Middle Name:CONNVIEL
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:9306 57TH AVE SW APT V101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-6130
Mailing Address - Country:US
Mailing Address - Phone:850-316-1580
Mailing Address - Fax:
Practice Address - Street 1:9306 57TH AVE SW APT V101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-6130
Practice Address - Country:US
Practice Address - Phone:850-316-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60715765376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide