Provider Demographics
NPI:1487293502
Name:GEORGE, ALISHA (RN)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NOSTRAND AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4032
Mailing Address - Country:US
Mailing Address - Phone:646-953-1656
Mailing Address - Fax:
Practice Address - Street 1:2400 NOSTRAND AVE APT 208
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4032
Practice Address - Country:US
Practice Address - Phone:646-953-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY777812163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse