Healthcare Provider Details

I. General information

NPI: 1467798066
Provider Name (Legal Business Name): IRMA ELISABETH GEHRUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CENTER ST
PORT JERVIS NY
12771-2806
US

IV. Provider business mailing address

9 CENTER ST
PORT JERVIS NY
12771-2806
US

V. Phone/Fax

Practice location:
  • Phone: 845-856-9703
  • Fax:
Mailing address:
  • Phone: 845-856-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number517530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: