Provider Demographics
NPI:1356367643
Name:ZICHITTELLA, GINA M (NP)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:ZICHITTELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:PISARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-283-8761
Practice Address - Fax:413-284-5117
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN252182363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0329363Medicaid
MAQ16012Medicare UPIN
MANP4552Medicare PIN