1336924661 NPI number — MISS GABRIELLE MARIE CONDE FNP-C

Table of content: MISS GABRIELLE MARIE CONDE FNP-C (NPI 1336924661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336924661 NPI number — MISS GABRIELLE MARIE CONDE FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDE
Provider First Name:
GABRIELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1336924661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 US HIGHWAY 1 BYP UNIT 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-7105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-410-6700
Provider Business Mailing Address Fax Number:
603-319-8308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 HARTFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02019-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-295-4355
Provider Business Practice Location Address Fax Number:
774-295-4880
Provider Enumeration Date:
08/25/2023

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: 363LF0000X , with the licence number:  RN2355973 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 121965500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com