1952321440 NPI number — AMY CHRISTINE GEORGE N.P.

Table of content: CASSANDRA LEIGH MARTINEZ FNP-BC (NPI 1407572993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952321440 NPI number — AMY CHRISTINE GEORGE N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
AMY
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANGEMAN
Provider Other First Name:
AMY
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952321440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4532 E PEAK VIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAVE CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85331-6292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-282-3676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90630-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-282-3676
Provider Business Practice Location Address Fax Number:
855-289-6637
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP2525 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 143275 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00625194 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".