Provider Demographics
NPI:1114815065
Name:GEORGE, NICOLE A (LPN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N WASHINGTON AVE STE 3340
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1800
Mailing Address - Country:US
Mailing Address - Phone:570-903-5838
Mailing Address - Fax:570-330-4045
Practice Address - Street 1:116 N WASHINGTON AVE STE 3340
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1800
Practice Address - Country:US
Practice Address - Phone:570-903-5838
Practice Address - Fax:570-330-4045
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN306573164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse