Healthcare Provider Details

I. General information

NPI: 1871322354
Provider Name (Legal Business Name): GINA CALO WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

IV. Provider business mailing address

194 HARNESS DR
SOUTHINGTON CT
06489-1866
US

V. Phone/Fax

Practice location:
  • Phone: 860-258-3480
  • Fax:
Mailing address:
  • Phone: 860-680-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number13578
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number13578
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: