Provider Demographics
NPI:1467079632
Name:GURZAK, CHAD EVAN (RN)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:EVAN
Last Name:GURZAK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1375
Mailing Address - Country:US
Mailing Address - Phone:716-592-9301
Mailing Address - Fax:
Practice Address - Street 1:27 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1375
Practice Address - Country:US
Practice Address - Phone:716-592-9301
Practice Address - Fax:716-592-9376
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687004-01163W00000X
NYF403831-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse