Provider Demographics
NPI:1558120345
Name:SPERA, GINA KATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:KATHLEEN
Last Name:SPERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SPERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:176 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2344
Mailing Address - Country:US
Mailing Address - Phone:203-313-5800
Mailing Address - Fax:
Practice Address - Street 1:176 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2344
Practice Address - Country:US
Practice Address - Phone:203-313-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY821699163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse