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General NPI Number Information
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NPI Number | 1023135936
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Entity Type | Individual
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Provider Name | LISA GRUENHUT GOLD N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 09/15/2018
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Provider Practice Location Address
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Address Line | 1 BUSHWICK RD STE B
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-3839
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Country | US
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Telephone | 845-654-0506
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Fax | 845-842-1361
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Provider Business Mailing Address
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Address Line | 108 HILLCREST LN
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City | PEEKSKILL
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State | NY
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Zip | 10566-6928
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Country | US
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Telephone | 845-216-0790
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Fax | 845-842-1361
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F331534
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 331534
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License Number State | NY
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