Healthcare Provider Details

I. General information

NPI: 1396751145
Provider Name (Legal Business Name): PHYLLIS ANNE GEHRING RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOND ST
SPRINGFIELD MA
01104-3401
US

IV. Provider business mailing address

25 BOND ST
SPRINGFIELD MA
01104-3401
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-4120
  • Fax:
Mailing address:
  • Phone: 413-731-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number262025-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number110764
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332218-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: