Provider Demographics
NPI:1023711074
Name:GOMEZ, IVETTE G (RN)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:G
Last Name:GOMEZ
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 1:6 PAM DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5214
Mailing Address - Country:US
Mailing Address - Phone:631-559-6795
Mailing Address - Fax:
Practice Address - Street 1:6 PAM DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5214
Practice Address - Country:US
Practice Address - Phone:631-559-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY617514-01163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine