Provider Demographics
NPI:1730260985
Name:GEORGE, MICHAEL (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 208TH DR
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-8109
Mailing Address - Country:US
Mailing Address - Phone:402-643-6095
Mailing Address - Fax:
Practice Address - Street 1:300 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2228
Practice Address - Country:US
Practice Address - Phone:402-643-2971
Practice Address - Fax:402-646-4654
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22970/100040367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered