Healthcare Provider Details

I. General information

NPI: 1407208408
Provider Name (Legal Business Name): DANA REBECCA GNERRE FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE NYU RADIOLOGY
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

560 1ST AVE NYU RADIOLOGY
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5230
  • Fax:
Mailing address:
  • Phone: 212-263-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number701683
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341438
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: