Provider Demographics
NPI:1558668764
Name:CHMELA, GINA C (APN)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:C
Last Name:CHMELA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:C
Other - Last Name:MANGIALARPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 S. VIRGINIA STREET
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7226
Mailing Address - Country:US
Mailing Address - Phone:815-444-9999
Mailing Address - Fax:815-986-1363
Practice Address - Street 1:145 S. VIRGINIA STREET
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7226
Practice Address - Country:US
Practice Address - Phone:815-444-9999
Practice Address - Fax:815-986-1363
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008640363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health