Basic Information
Provider Information
NPI: 1548673569
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GURSKI
FirstName: ERIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 650859 DEPT 710
Address2:  
City: DALLAS
State: TX
PostalCode: 752653217
CountryCode: US
TelephoneNumber: 4097722222
FaxNumber:  
Practice Location
Address1: 301 UNIVERSITY BLVD
Address2:  
City: GALVESTON
State: TX
PostalCode: 775552546
CountryCode: US
TelephoneNumber: 4097722222
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/06/2014
LastUpdateDate: 06/24/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/24/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAP125761TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
AP12576101TXTEXAS BOARD OF NURSINGOTHER


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