Provider Demographics
NPI:1093117012
Name:INTRAVERSATO, GINA (RN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:INTRAVERSATO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:HUMAROCK
Mailing Address - State:MA
Mailing Address - Zip Code:02047-0075
Mailing Address - Country:US
Mailing Address - Phone:781-733-0000
Mailing Address - Fax:
Practice Address - Street 1:11 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-4432
Practice Address - Country:US
Practice Address - Phone:781-733-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN230769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse