=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346643079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA GURLEY R.N
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2014
-----------------------------------------------------
Last Update Date | 10/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 BUENA VISTA DR
-----------------------------------------------------
City | GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06831-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-915-6977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 BUENA VISTA DR
-----------------------------------------------------
City | GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06831-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-915-6977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Registered Nurse
-----------------------------------------------------
License Number | 22 474971
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------