Basic Information
| Provider Information | |||||||||
| NPI: | 1063075257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAURER | ||||||||
| FirstName: | GEMMA | ||||||||
| MiddleName: | CASTRO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 LIVERNOIS RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486808203 | ||||||||
| FaxNumber: | 2486808030 | ||||||||
| Practice Location | |||||||||
| Address1: | ASCENSION PROVIDENCE HOSPITAL | ||||||||
| Address2: | 47601 GRAND RIVER AVE | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484655350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 12/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 4704232066 | MI | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LA2100X | 4704232066 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.