Provider Demographics
NPI:1750723532
Name:GEORGE, NISHA S
Entity type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:S
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MCHENRY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6705
Mailing Address - Country:US
Mailing Address - Phone:847-618-0351
Mailing Address - Fax:847-618-0766
Practice Address - Street 1:15 S MCHENRY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6705
Practice Address - Country:US
Practice Address - Phone:847-618-0351
Practice Address - Fax:847-618-0766
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily