Basic Information
| Provider Information | |||||||||
| NPI: | 1376004705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GULLEY | ||||||||
| FirstName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 E AMES CT | ||||||||
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| City: | PLAINVIEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118032317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164145865 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4150 SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117585303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163931000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 104822247 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.