Healthcare Provider Details

I. General information

NPI: 1881871051
Provider Name (Legal Business Name): REGINA GISMONDI APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 WALNUT ST 604 CURTIS BUILDING- DEPARTMENT OF SURGERY
PHILADELPHIA PA
19107-5005
US

IV. Provider business mailing address

305 MARLBOROUGH AVE
W COLLS HGTS NJ
08059-1922
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-9991
  • Fax:
Mailing address:
  • Phone: 856-349-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP009635
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: