Provider Demographics
NPI:1457616336
Name:CIANCIA, GINA M (RN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:CIANCIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 KINNEY DR
Mailing Address - Street 2:104
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05464-6202
Mailing Address - Country:US
Mailing Address - Phone:215-498-7721
Mailing Address - Fax:
Practice Address - Street 1:134 KINNEY DR
Practice Address - Street 2:104
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464-6202
Practice Address - Country:US
Practice Address - Phone:215-498-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0260029249163W00000X
NY5545131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse