Provider Demographics
NPI:1265192363
Name:LOSE, GEORGEANNE (CRNP)
Entity type:Individual
Prefix:
First Name:GEORGEANNE
Middle Name:
Last Name:LOSE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MIRA VISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3225
Mailing Address - Country:US
Mailing Address - Phone:256-763-3268
Mailing Address - Fax:
Practice Address - Street 1:HUNTSVILLE HOSPITAL AUTHORITY
Practice Address - Street 2:101 SIVLEY ROAD
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-265-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1089692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL245998OtherEMPLOYEE ID