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General NPI Number Information
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NPI Number | 1154109718
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Entity Type | Individual
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Provider Name | ALYSSA MARIE GAMBARDELLA APRN
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Gender | Female
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 4 GROVE BEACH RD N STE 1B
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City | WESTBROOK
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State | CT
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Zip | 06498-1656
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Country | US
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Telephone | 475-434-2960
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Fax |
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Provider Business Mailing Address
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Address Line | 14307 MAPLE TREE LN
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City | EAST LYME
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State | CT
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Zip | 06333-1757
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Country | US
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Telephone | 860-754-4234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 12373
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License Number State | CT
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