Individual
NICHOLAS GAMMELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18510 STATE HIGHWAY 371 STE D, BRAINERD, MN 56401-6996
(218) 838-4209
Mailing address
11636 FAIRWAY RD, EAST GULL LAKE, MN 56401-2099
(218) 838-4209
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1437
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62Q99GA
BLUE CROSS
MN
05
—
731353500
—
MN
Enumeration date
07/24/2006
Last updated
11/19/2024
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