Healthcare Provider Details

I. General information

NPI: 1538493507
Provider Name (Legal Business Name): PURVA GIRISH GUMASTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N ALPHA ST
GRAND ISLAND NE
68803-4320
US

IV. Provider business mailing address

800 N ALPHA ST
GRAND ISLAND NE
68803-4320
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-2010
  • Fax:
Mailing address:
  • Phone: 308-382-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number28476
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: