Provider Demographics
NPI:1790520625
Name:MERSONIA, GINA MARIE
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:MERSONIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 MILLBANK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2243
Mailing Address - Country:US
Mailing Address - Phone:941-268-1640
Mailing Address - Fax:
Practice Address - Street 1:325 MILLETT HALL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45435-0001
Practice Address - Country:US
Practice Address - Phone:937-775-3490
Practice Address - Fax:937-775-3434
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program