Provider Demographics
NPI:1912596602
Name:GONDEK, KENIA (APRN)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:GONDEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NORTHWESTERN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3416
Mailing Address - Country:US
Mailing Address - Phone:860-242-6297
Mailing Address - Fax:
Practice Address - Street 1:6 NORTHWESTERN DR STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3416
Practice Address - Country:US
Practice Address - Phone:860-242-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12919363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care