Healthcare Provider Details

I. General information

NPI: 1265120455
Provider Name (Legal Business Name): NICOLE GENDRON-TRAINER CNS-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12112 MAIDENHAIR DR
GAINESVILLE VA
20155-3871
US

IV. Provider business mailing address

12112 MAIDENHAIR DR
GAINESVILLE VA
20155-3871
US

V. Phone/Fax

Practice location:
  • Phone: 571-277-2533
  • Fax:
Mailing address:
  • Phone: 571-277-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number0024181858
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: