Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0192721 | IL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1014759 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | F10170483 | IL |
NPI | 1083126353 |
---|---|
Provider Name | Gerthy Cipus Pierre |
First Address | Long Beach, CA 90802-4317 |
Second Address | Edwardsville, IL 62025-5500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2017 |
Last Update Date | 22/12/2020 |