1427693415 NPI number — ERIK GUMBS

Table of content: ERIK GUMBS (NPI 1427693415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427693415 NPI number — ERIK GUMBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUMBS
Provider First Name:
ERIK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUMBS
Provider Other First Name:
ERIQUE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1427693415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 BLACKBIRD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-8633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-229-2976
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19901-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-857-5060
Provider Business Practice Location Address Fax Number:
302-857-5061
Provider Enumeration Date:
11/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  LP-0000324 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LP-0000324 . This is a "STATE OF DELAWARE LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: AG05190078 . This is a "THE AMERICAN ASSOCIATION OF NURSE PRACTITIONERS" identifier . This identifiers is of the category "OTHER".




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