GINA M. CONNOLLY NP NPI 1023364262

NPI Information

NPI: 1023364262
Provider Name: GINA M. CONNOLLY, NP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
100 NAVARRE PL STE 6600
SOUTH BEND, IN
ZIP 46601
Phone: (574) 647-8800
Get Directions

Gina M. Connolly, NP is an adult health nurse practitioner in South Bend, IN with 12 years of experience. Gina M. Connolly, NP NPI is 1023364262. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

100 NAVARRE PL STE 6600
SOUTH BEND, IN
ZIP 46601-173
Phone: (574) 647-8800
Fax: (574) 647-8811

The NPI 1023364262 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/25/2012 and was last updated on 3/31/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	71004080A	INDIANA	Yes
2	363LG0600X	Nurse Practitioner	Gerontology	71004080A	INDIANA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	201090780	MEDICAID	INDIANA
2	327270010	OTHER	INDIANA	MEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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