Provider Demographics
NPI:1679915706
Name:GYURA, PHILIP JOSEPH (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOSEPH
Last Name:GYURA
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAYMOND AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1778
Mailing Address - Country:US
Mailing Address - Phone:612-895-1510
Mailing Address - Fax:833-979-0945
Practice Address - Street 1:700 RAYMOND AVE STE 130
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1778
Practice Address - Country:US
Practice Address - Phone:612-895-1510
Practice Address - Fax:833-979-0945
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-190688-6163W00000X
NY657718163W00000X
NYF338490-1363LF0000X
MN5139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse