Basic Information
| Provider Information | |||||||||
| NPI: | 1194487413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | SONIA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 434 SW WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760285330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174471208 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 434 SW WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760285330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174471208 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2021 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 896487 | TX | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 363L00000X | 1059142 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.