Provider Demographics
NPI:1629398177
Name:GIPP, NICOLE E (CRNA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:GIPP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1300
Mailing Address - Country:US
Mailing Address - Phone:203-384-3174
Mailing Address - Fax:203-384-4619
Practice Address - Street 1:7365 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1300
Practice Address - Country:US
Practice Address - Phone:203-384-3174
Practice Address - Fax:203-384-4619
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT082127163W00000X
CT004409367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400021266Medicare UPIN