Provider Demographics
NPI:1164114211
Name:GOMES, NELSON JOAO (RN)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:JOAO
Last Name:GOMES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2940
Mailing Address - Country:US
Mailing Address - Phone:203-306-7229
Mailing Address - Fax:
Practice Address - Street 1:40 ALBERT ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1542
Practice Address - Country:US
Practice Address - Phone:203-865-0068
Practice Address - Fax:203-401-4580
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107564163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control