Provider Demographics
NPI:1750071908
Name:GEORGE, NISHA MARY (RN, APRN, AGACNP)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:MARY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RN, APRN, AGACNP
Other - Prefix:
Other - First Name:NISHA
Other - Middle Name:MARY
Other - Last Name:POULOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:981 STATE HIGHWAY 121 STE 1140
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6148
Practice Address - Country:US
Practice Address - Phone:469-697-5100
Practice Address - Fax:469-697-5105
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098461363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care