Provider Demographics
NPI:1417477845
Name:GEARING, DORIS FAY (LPN)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:FAY
Last Name:GEARING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DORIS
Other - Middle Name:FAY
Other - Last Name:GEARING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1285 BUNCOMBE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-2537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:922 BLY ST
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:IL
Practice Address - Zip Code:36295
Practice Address - Country:US
Practice Address - Phone:618-306-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.067512164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse