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General NPI Number Information
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NPI Number | 1578246625
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Entity Type | Individual
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Provider Name | LISSETTE GURGES FNP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 281 HUDSON ST
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City | NEW YORK
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State | NY
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Zip | 10013-1412
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Country | US
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Telephone | 332-239-7305
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Fax |
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Provider Business Mailing Address
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Address Line | 44 CROFT PL
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6508
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Country | US
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Telephone | 347-372-2272
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 351411
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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 | F351411
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License Number State | NY
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