Individual
GINA DECENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
123 SUMMER ST, WORCESTER, MA 01608-1216
(978) 407-0553
Mailing address
123 SUMMER ST, WORCESTER, MA 01608-1216
(508) 363-5000
(508) 363-7551
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN274732
MA
363LA2100X
Acute Care Nurse Practitioner
Primary
RN274732
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1301071
GROUP MEDICAID NUMBER
MA
Enumeration date
02/01/2010
Last updated
10/24/2014
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