Provider Demographics
NPI:1407857253
Name:GEORGE, JOAN MARIE (PA)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4855
Mailing Address - Country:US
Mailing Address - Phone:402-483-4571
Mailing Address - Fax:
Practice Address - Street 1:4600 VALLEY RD
Practice Address - Street 2:SIUTE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4855
Practice Address - Country:US
Practice Address - Phone:402-483-4571
Practice Address - Fax:402-483-5079
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE272248GEMedicare ID - Type Unspecified
NES94481Medicare UPIN