Provider Demographics
NPI:1164054631
Name:GEMMELL, ERICA LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:GEMMELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2700
Mailing Address - Country:US
Mailing Address - Phone:608-666-6951
Mailing Address - Fax:
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2700
Practice Address - Country:US
Practice Address - Phone:608-666-6951
Practice Address - Fax:860-667-6875
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily