Provider Demographics
NPI:1780369181
Name:GARRITY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GARRITY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 CALLE FUERTE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 E DECATUR ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1566
Practice Address - Country:US
Practice Address - Phone:402-372-2404
Practice Address - Fax:402-372-6770
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE3204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program