Gwendolyn Lorraine Bates, LPN
Individual provider Active NPI Licensed Practical Nurse · Roosevelt, NY
NPI 1669629028 · NPPES record last updated Jul 1, 2009
Key facts
- NPI
- 1669629028
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 217368 (NY)
- Practice address
- 74 Delisle Ave
Roosevelt, NY 11575-2443 - Phone
- (516) 413-7243
- NPI assigned
- Aug 27, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 217368 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 217368 | NY | Yes |
Addresses
Primary practice location
74 Delisle Ave
Roosevelt, NY 11575-2443
Mailing address
74 Delisle Ave
Roosevelt, NY 11575-2443
Phone (516) 413-7243
Other providers in Roosevelt, NY
- Sonia Pauline Baker
- Charity Barao
- Jyoti Bariana
- Gem Magdalen Barton
- Perlita Basilio
- Sharon Lynn Bates
- Angelik Bell
- Belle Cleaning Services LLC
- Belle Social Resources
- Laura Marie Belluomo
All providers in Roosevelt, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.