1205208238 NPI number — MS. MARY M GILBERTSON MSN,APRN, FNP-BC,

Table of content: MS. MARY M GILBERTSON MSN,APRN, FNP-BC, (NPI 1205208238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205208238 NPI number — MS. MARY M GILBERTSON MSN,APRN, FNP-BC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBERTSON
Provider First Name:
MARY
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN,APRN, FNP-BC,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205208238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6515 MAIN ST STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-1388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-521-4733
Provider Business Mailing Address Fax Number:
203-880-9484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6515 MAIN ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-1388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-521-4733
Provider Business Practice Location Address Fax Number:
203-521-4733
Provider Enumeration Date:
10/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 202D00000X , with the licence number:  9253 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205208238 . This is a "APRN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com