Provider Demographics
NPI:1043701998
Name:GENDREAU, NICOLE ALYSE (FNP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ALYSE
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32 STRAWBERRY HILL COURT
Mailing Address - Street 2:4TH FLOOR, SUITE 6
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-276-2566
Mailing Address - Fax:203-276-2568
Practice Address - Street 1:32 STRAWBERRY HILL COURT
Practice Address - Street 2:4TH FLOOR, SUITE 6
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-276-2566
Practice Address - Fax:203-276-2568
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2321725163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse