Provider Demographics
NPI:1356748446
Name:DEHMER, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DEHMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 NEWMAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE COMO
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1722 NEWMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE COMO
Practice Address - State:NJ
Practice Address - Zip Code:07719-3065
Practice Address - Country:US
Practice Address - Phone:973-271-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
NJ26NR12676700163W00000X, 163WI0500X
NY679756-1163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy