Provider Demographics
NPI:1477635340
Name:GNAZZO, DENISE CYNTHIA (NP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:CYNTHIA
Last Name:GNAZZO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:DENISE
Other - Middle Name:CYNTHIA
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:15 ROCHE BROTHERS WAY SUITE 220
Mailing Address - Street 2:ONE WASHINGTON PLACE
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1000
Mailing Address - Country:US
Mailing Address - Phone:508-238-4627
Mailing Address - Fax:
Practice Address - Street 1:15 ROCHE BROTHERS WAY SUITE 220
Practice Address - Street 2:ONE WASHINGTON PLACE
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1000
Practice Address - Country:US
Practice Address - Phone:508-238-4627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP4667Medicare ID - Type Unspecified