Healthcare Provider Details

I. General information

NPI: 1114713864
Provider Name (Legal Business Name): ANNA L GURROLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WOODLEY PARK RD
GERING NE
69341-1633
US

IV. Provider business mailing address

1105 E 14TH ST
SCOTTSBLUFF NE
69361-3311
US

V. Phone/Fax

Practice location:
  • Phone: 308-672-2066
  • Fax:
Mailing address:
  • Phone: 308-672-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: