Provider Demographics
NPI:1679465587
Name:GEORGE, MICHAELA RYANNE (CNP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:RYANNE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 VERNA DR
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-9503
Mailing Address - Country:US
Mailing Address - Phone:304-415-5441
Mailing Address - Fax:
Practice Address - Street 1:3415 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1334
Practice Address - Country:US
Practice Address - Phone:304-388-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103215363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner