Connolly, Gina M.

Connolly, Gina M. is an individual health care provider with primary practice located at 100 Navarre Pl Ste 6600 , South Bend IN 46601-1173. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Connolly, Gina M. can be contacted via phone (574) 647-8800.

Contact Information

Primary practice address
100 Navarre Pl Ste 6600 South Bend IN 46601-1173
Phone: (574) 647-8800
Fax: (574) 647-8811
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 71004080A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 71004080A Indiana

Profile Details

NPI number 1023364262
LBN Legal business name Connolly, Gina M.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 25th, 2012
Last updated Mar 31st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023364262 NPPES
Indiana MEDICAID 201090780
Indiana Other 327270010

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