Provider Demographics
NPI:1275850364
Name:WESTBROOK, GWENDOLYN ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:ANN
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:GWENDOLYN
Other - Middle Name:ANN
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:600 BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2204
Mailing Address - Country:US
Mailing Address - Phone:585-698-6197
Mailing Address - Fax:
Practice Address - Street 1:600 BROOKS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2204
Practice Address - Country:US
Practice Address - Phone:585-698-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217657-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse