Provider Demographics
NPI:1467721530
Name:DEANE, GLADYS MAE (LPN)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:MAE
Last Name:DEANE
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 1:117 SNYDERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZAVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12523-1345
Mailing Address - Country:US
Mailing Address - Phone:845-756-4810
Mailing Address - Fax:
Practice Address - Street 1:2829 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567-5545
Practice Address - Country:US
Practice Address - Phone:518-398-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse