Healthcare Provider Details

I. General information

NPI: 1891900528
Provider Name (Legal Business Name): GINA ALESSIA RN, BSN,APN-CNS,CWCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W 61ST AVE
HOBART IN
46342-6490
US

IV. Provider business mailing address

320 W 61ST AVE
HOBART IN
46342-6490
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6448
  • Fax: 219-947-6839
Mailing address:
  • Phone: 773-706-2306
  • Fax: 708-633-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number41251928
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number28211957A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: