Provider Demographics
NPI:1205191608
Name:RAPP, GINA LISA (RN)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LISA
Last Name:RAPP
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 1:431 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:EARLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13332-3101
Mailing Address - Country:US
Mailing Address - Phone:607-627-9606
Mailing Address - Fax:
Practice Address - Street 1:6678 COUNTY ROAD 32
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3554
Practice Address - Country:US
Practice Address - Phone:607-335-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600040-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse