Provider Demographics
NPI:1427394600
Name:GANDY, BETTY J (LPN)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:J
Last Name:GANDY
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 1:2403 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3103
Mailing Address - Country:US
Mailing Address - Phone:716-622-7668
Mailing Address - Fax:
Practice Address - Street 1:2403 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-3103
Practice Address - Country:US
Practice Address - Phone:716-622-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122330164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse