Provider Demographics
NPI:1164189023
Name:COMPERE, GINA (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:COMPERE
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 GORE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1119
Mailing Address - Country:US
Mailing Address - Phone:617-575-2672
Mailing Address - Fax:
Practice Address - Street 1:163 GORE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1119
Practice Address - Country:US
Practice Address - Phone:617-575-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291469163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-30-1965OtherBIRTH DATE
04301965OtherDATE OF BIRTH
MARN2291469Medicaid