Provider Demographics
NPI:1083038566
Name:DOUGLAS, GESSIKA ANALISE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:GESSIKA
Middle Name:ANALISE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:SCHUYLER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:13457-0154
Mailing Address - Country:US
Mailing Address - Phone:607-267-2605
Mailing Address - Fax:
Practice Address - Street 1:41 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:RICHFIELD SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13439
Practice Address - Country:US
Practice Address - Phone:607-267-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310708164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse