Provider Demographics
NPI:1225401995
Name:GHEMMEGNE, ESTELLE (LPN)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:GHEMMEGNE
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 1:24 SEAN RILEY
Mailing Address - Street 2:# 3
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1494
Mailing Address - Country:US
Mailing Address - Phone:716-906-4418
Mailing Address - Fax:
Practice Address - Street 1:24 SEAN RILEY
Practice Address - Street 2:# 3
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1494
Practice Address - Country:US
Practice Address - Phone:716-906-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320252-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse