Healthcare Provider Details

I. General information

NPI: 1285866806
Provider Name (Legal Business Name): GAYLE GWOZDZ A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2009
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 WOLCOTT RD
WOLCOTT CT
06716-2626
US

IV. Provider business mailing address

161 FOUR ROD RD
BERLIN CT
06037-2226
US

V. Phone/Fax

Practice location:
  • Phone: 203-623-4560
  • Fax:
Mailing address:
  • Phone: 860-829-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number004152
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: