Provider Demographics
NPI:1467834804
Name:JAPA, GLADYS M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:M
Last Name:JAPA
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 1:3217 102ND ST
Mailing Address - Street 2:APT1A
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-2511
Mailing Address - Country:US
Mailing Address - Phone:718-730-4403
Mailing Address - Fax:
Practice Address - Street 1:3217 102ND ST
Practice Address - Street 2:APT1A
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-2511
Practice Address - Country:US
Practice Address - Phone:718-730-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314377-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse