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NPI Code Detail

MEDICARE: PHILIP JOSEPH GYURA DNP, FNP-BC

MEDICARE: PHILIP JOSEPH GYURA DNP, FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseR-190688-6MN
2163W00000XRegistered Nurse657718NY
3363LF0000XFamily Nurse PractitionerF338490-1NY
4363LF0000XFamily Nurse Practitioner5139MN

General Provider Information

NPI Number : 1679915706
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP JOSEPH GYURA DNP, FNP-BC
Provider Business Mailing Address
First Line : 700 RAYMOND AVE STE 130
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1778
Country : US
Telephone Number : 612-895-1510
Fax Number : 833-979-0945
Provider Business Practice Location Address
First Line : 700 RAYMOND AVE STE 130
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1778
Country : US
Telephone Number : 612-895-1510
Fax Number : 833-979-0945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2013
Last Update Date : 12/16/2021

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