Provider Demographics
NPI:1629312624
Name:GMYREK, ALICE (RN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:GMYREK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 KING ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3258
Mailing Address - Country:US
Mailing Address - Phone:413-582-9500
Mailing Address - Fax:413-585-1410
Practice Address - Street 1:216 N KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1120
Practice Address - Country:US
Practice Address - Phone:413-582-9500
Practice Address - Fax:413-585-1410
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN174062163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health