Provider Demographics
NPI:1790375764
Name:GUBBINE, ELAINE CAROL (RN REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:CAROL
Last Name:GUBBINE
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9783
Mailing Address - Country:US
Mailing Address - Phone:856-451-1812
Mailing Address - Fax:
Practice Address - Street 1:492 IRVING AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-9783
Practice Address - Country:US
Practice Address - Phone:856-451-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11749300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NR11749300OtherREGISTERED NURSE