Jerry Gordon Carnovsky, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704185415 Issued in MI

Practice address

28000 Woodward Ave Ste 100
Royal Oak, MI 48067-0961

Phone

(248) 395-3777

NPI assigned

Apr 6, 2020

Last updated

Apr 6, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1174152789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 WOODWARD AVE STE 100",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480670961",
            "telephone_number": "248-395-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28000 WOODWARD AVE STE 100",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480670961",
            "telephone_number": "248-395-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARNOVSKY",
        "first_name": "JERRY",
        "middle_name": "GORDON",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704185415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4704185415",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Theresa A Carrier-Torrealba, FNP-C

• Registered Nurse in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.