Provider Demographics
NPI:1780379305
Name:COPPOLA, GABRIELLE BOBBI (CNM/NP)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:BOBBI
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:CNM/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CONGRESS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0907
Mailing Address - Country:US
Mailing Address - Phone:617-479-6636
Mailing Address - Fax:617-472-9868
Practice Address - Street 1:300 CONGRESS ST STE 102
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0907
Practice Address - Country:US
Practice Address - Phone:617-479-6636
Practice Address - Fax:617-472-9868
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2317033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health