Provider Demographics
NPI:1417618562
Name:CARREON, IRIS GANCINIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:GANCINIA
Last Name:CARREON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:BUENAGUA
Other - Last Name:GANCINIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4486 LASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2750
Mailing Address - Country:US
Mailing Address - Phone:770-776-8859
Mailing Address - Fax:
Practice Address - Street 1:4486 LASHLEY DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2750
Practice Address - Country:US
Practice Address - Phone:770-776-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN237347163WP0809X, 163WX0200X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WX0200XNursing Service ProvidersRegistered NurseOncology