Healthcare Provider Details

I. General information

NPI: 1770698508
Provider Name (Legal Business Name): NELSON P GURNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4857 MANHATTAN DR
ROCKFORD IL
61108-2265
US

IV. Provider business mailing address

4857 MANHATTAN DR
ROCKFORD IL
61108-2265
US

V. Phone/Fax

Practice location:
  • Phone: 815-399-0599
  • Fax: 815-399-2499
Mailing address:
  • Phone: 815-399-0599
  • Fax: 815-399-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3642511
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: