Provider Demographics
NPI:1720898810
Name:CANNOVA, GINA KATHLEEN
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:KATHLEEN
Last Name:CANNOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GOLD RD APT 2
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5022
Mailing Address - Country:US
Mailing Address - Phone:845-685-8373
Mailing Address - Fax:
Practice Address - Street 1:55 GOLD RD APT 2
Practice Address - Street 2:
Practice Address - City:STORMVILLE
Practice Address - State:NY
Practice Address - Zip Code:12582-5022
Practice Address - Country:US
Practice Address - Phone:845-685-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339701164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse