Iris Gancinia Carreon, RN

Primary specialty

Medical-Surgical Registered NurseTaxonomy code 163WM0705X

License

RN237347 Issued in GA

Practice address

4486 Lashley Dr
Tucker, GA 30084-2750

Phone

(770) 776-8859

NPI assigned

Dec 31, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Iris Buenagua Gancinia Former name

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": "1640908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640908800000",
    "number": "1417618562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4486 LASHLEY DR",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300842750",
            "telephone_number": "770-776-8859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4486 LASHLEY DR",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300842750",
            "telephone_number": "770-776-8859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARREON",
        "first_name": "IRIS",
        "middle_name": "GANCINIA",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-31",
        "last_updated": "2021-12-31",
        "certification_date": "2021-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "GA",
            "license": "RN237347",
            "primary": false
        },
        {
            "code": "163WX0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Oncology",
            "state": "GA",
            "license": "RN237347",
            "primary": false
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "GA",
            "license": "RN237347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRIS",
            "last_name": "GANCINIA",
            "middle_name": "BUENAGUA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical-Surgical Registered Nurse in Tucker, GA
• Providers in Tucker, GA by specialty
• Medical-Surgical Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2021; 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.