Provider Demographics
NPI:1437895190
Name:KLUSTY, GAIL P (LPN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:P
Last Name:KLUSTY
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 1:748 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3718
Mailing Address - Country:US
Mailing Address - Phone:330-697-3858
Mailing Address - Fax:
Practice Address - Street 1:748 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3718
Practice Address - Country:US
Practice Address - Phone:330-697-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH062738164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse