Provider Demographics
NPI:1467238493
Name:GLEASON, KAITLYN ANN (RN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:GLEASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-1100
Mailing Address - Country:US
Mailing Address - Phone:607-654-2729
Mailing Address - Fax:
Practice Address - Street 1:35 VICTORY HWY
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-1006
Practice Address - Country:US
Practice Address - Phone:607-654-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY750990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse