Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME116251 | FL |
NPI | 1508165762 |
---|---|
Provider Name | Lori Gurien |
First Address | Little Rock, AR 72202-3500 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2011 |
Last Update Date | 22/06/2021 |