Individual
GINA M. CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
738 E OAK HILL RD, CHESTERTON, IN 46304-1360
(317) 672-5226
(574) 237-6069
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71004080A
IN
363LG0600X
Gerontology Nurse Practitioner
71004080A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201090780
—
IN
01
—
327270010
MEDICARE PTAN
IN
Enumeration date
07/25/2012
Last updated
05/06/2026
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