Provider Demographics
NPI:1912684879
Name:GEORGE, DECONTEE PHILOMENA
Entity Type:Individual
Prefix:MS
First Name:DECONTEE
Middle Name:PHILOMENA
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 1:6380 BUSCH BLVD APT 362
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1847
Mailing Address - Country:US
Mailing Address - Phone:614-632-3632
Mailing Address - Fax:
Practice Address - Street 1:6380 BUSCH BLVD APT 362
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1847
Practice Address - Country:US
Practice Address - Phone:614-632-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.NP.0034122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily