Vereen Gouldburne, NURSE PRACTITIONER

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

26NJ01327000 Issued in NJ

Practice address

1161 Katherine St
Teaneck, NJ 07666-4811

Phone

(201) 249-9407

NPI assigned

Jan 26, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1674691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1790491363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1161 KATHERINE ST",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664811",
            "telephone_number": "201-249-9407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1161 KATHERINE ST",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664811",
            "telephone_number": "201-249-9407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULDBURNE",
        "first_name": "VEREEN",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-26",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NJ",
            "license": "26NJ01327000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devon Cordelia Gordon-Lyles, AGPNP-BC, CCRN
• Adam Gabriel Gordon, OTR/L
• Alexander J. Gordon, PH.D.
• Benjamin Gottesman, PSY.D.
• Rachael Gottesman
• Taylor Grader, PA-C
• Francis Joseph Graham, DMD
• Marylin Joan Granat, MSW LCSW BCD
• Susan L. Grand, PHD
• Peter Anthony Gratale, D.C.

• Primary Care Nurse Practitioner in Teaneck, NJ
• Providers in Teaneck, NJ by specialty
• Primary Care Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.