GINA M. CONNOLLY (NPI# 1023364262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023364262 |
| Entity Type | Individual |
| Full Name | GINA M. CONNOLLY |
| Credential | NP |
| Practice Address |
100 Navarre Pl Ste 6600 South Bend IN 46601 |
| Mailing Address |
710 N Niles Ave South Bend IN 46617-1924 |
| Practice Telephone | 5746478800 |
| Practice Fax Number | 5746478811 |
| Mailing Telephone | 5746471610 |
| Mailing Fax Number | 5742376069 |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2020-08-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
71004080A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
71004080A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | MEDICARE PTAN | 327270010 | 01 |
| IN | 201090780 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3500 Franciscan Way Ste 300, Michigan City, IN 463600021 | 2192144633 | 2192144568 |
| 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 5746478800 | 5746478811 |
| Street Address |
100 NAVARRE PL STE 6600 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861421141 | Beacon Medical Group, Inc. | Psychiatry & Neurology | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2006-06-30 |
| 1851818132 | Laura C Wilkerson | Nurse Practitioner | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2017-08-27 |
| 1639521370 | Natalie Hauser | Nurse Practitioner | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2016-07-06 |
| 1912359662 | Heidi Schelstraete | Nurse Practitioner | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2016-07-06 |
| 1841695590 | Kyle Moser | Physician Assistant | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2014-10-23 |
| 1780098780 | Christopher Frederick Ketcham | Physical Medicine & Rehabilitation | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2014-06-17 |
| 1417243189 | Kashif Ajaz Shaikh | Neurological Surgery | 100 Navarre Pl Ste 6600, South Bend, IN 46601-1173 | 2011-06-21 |
| 1386802387 | Daniel H Fulkerson | Neurological Surgery | 100 Navarre Pl Ste 6600, South Bend, IN 46601 | 2008-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447610449 | David Thomas | Hearing Instrument Specialist | 808 S Michigan St., South Bend, IN 46601 | 2016-03-03 |
| 1285072454 | Kevin Francis Cumper | Internal Medicine | 621 Memorial Dr Ste 624, South Bend, IN 46601 | 2013-06-11 |
| 1952605560 | Robert Lusk Bonham | Dentist | 1222 L.w.e., So. Bend, IN 46601 | 2010-12-23 |
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1528390770 | Luke Alfred White | Internal Medicine | 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 | 2010-02-12 |
| 1548497837 | Tmg Home Health Care | Home Health | 108 N Main St #305, South Bend, IN 46601 | 2009-06-15 |
| 1225283039 | Jody L. Hughes | Counselor | 202 S. Michigan Street, Suite 875, South Bend, IN 46601 | 2008-11-20 |
| 1740432574 | Amanda Jayne Quicksall | Social Worker | 611 Lincolnway W, South Bend, IN 46601 | 2008-10-10 |
| 1952565772 | Thomas P Judd | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 | 2008-07-10 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| Find all providers in zip 46601 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083262992 | Francesca E Udoh | Nurse Practitioner | 51875 Whitestable Ln, South Bend, IN 46637-1371 | 2019-09-04 |
| 1760721807 | William John Fox | Nurse Practitioner | 333 W Western Ave, South Bend, IN 46601-2215 | 2013-02-09 |
| 1922290790 | Laura Myers Hieronymus | Nurse Practitioner | 1700 Mishawaka Ave, Student Activity Center Rm 130, South Bend, IN 46634-7111 | 2007-08-15 |
| 1740296516 | Freda Ann Black | Nurse Practitioner | 112 W Jefferson Blvd, South Bend, IN 46601-1923 | 2006-07-31 |
| 1447721105 | Daniela M Edson | Nurse Practitioner | 621 Memorial Dr Ste 502, South Bend, IN 46601-1075 | 2018-12-06 |
| 1265810584 | Tara Pousson | Nurse Practitioner | 112 W Jefferson Blvd, Suite 600, South Bend, IN 46601-1923 | 2015-05-07 |
| 1447669304 | Ludmila Pichugena-emerson | Nurse Practitioner | 211 N Eddy St., South Bend, IN 46617-3096 | 2014-08-05 |
| 1033520101 | Oluyinka Grace Osunnuga | Nurse Practitioner | 707 N Michigan St, Suite 400, South Bend, IN 46601-1067 | 2014-05-12 |
| 1972913804 | Toni Brown | Nurse Practitioner | 333 W Western Ave, South Bend, IN 46601-2215 | 2014-04-30 |
| 1518302264 | Beacon Medical Group, Inc. | Nurse Practitioner | 621 Memorial Dr, Suite 602, South Bend, IN 46601-1063 | 2013-05-08 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
Please comment or provide details below to improve the information on GINA M. CONNOLLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.