Provider Demographics
NPI:1861454498
Name:GILDEA, MARGUERITE (APRN)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:GILDEA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OUTLOOK AVE
Mailing Address - Street 2:APT 306
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1449
Mailing Address - Country:US
Mailing Address - Phone:860-523-1926
Mailing Address - Fax:860-755-3603
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:MAIL STOP 124-10
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-0968
Practice Address - Country:US
Practice Address - Phone:860-565-2537
Practice Address - Fax:860-755-3603
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001877363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health