Provider Demographics
NPI:1770302242
Name:BONGIORNO, GLORIA JULISSA (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:JULISSA
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:RI
Mailing Address - Zip Code:02802-1112
Mailing Address - Country:US
Mailing Address - Phone:401-374-6534
Mailing Address - Fax:
Practice Address - Street 1:711 W CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1542
Practice Address - Country:US
Practice Address - Phone:508-583-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN04300363L00000X
MARN2262916363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care