Provider Demographics
NPI:1245896414
Name:GONNELLA, NICOLA (BS)
Entity type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:
Last Name:GONNELLA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 HECKEL ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1005
Mailing Address - Country:US
Mailing Address - Phone:862-201-9886
Mailing Address - Fax:
Practice Address - Street 1:173 HECKEL ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1005
Practice Address - Country:US
Practice Address - Phone:862-201-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty