Healthcare Provider Details

I. General information

NPI: 1164054631
Provider Name (Legal Business Name): ERICA LYNN GEMMELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2700
US

IV. Provider business mailing address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2700
US

V. Phone/Fax

Practice location:
  • Phone: 608-666-6951
  • Fax: 860-667-6875
Mailing address:
  • Phone: 608-666-6951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8709
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: