Provider Demographics
NPI:1215389622
Name:METELLUS, GERTRUDE (LPN)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:
Last Name:METELLUS
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 1:5031 HERON CT
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2413
Mailing Address - Country:US
Mailing Address - Phone:954-234-4125
Mailing Address - Fax:
Practice Address - Street 1:5031 HERON CT
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2413
Practice Address - Country:US
Practice Address - Phone:954-234-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5151800164W00000X
CAVN684421164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse