Provider Demographics
NPI:1497065866
Name:GASPAR, DIVINA GRACIA DINGLASAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIVINA GRACIA
Middle Name:DINGLASAN
Last Name:GASPAR
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 1:43 ROME AVENUE
Mailing Address - Street 2:APT 5A
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507
Mailing Address - Country:US
Mailing Address - Phone:914-666-7972
Mailing Address - Fax:
Practice Address - Street 1:43 ROME AVENUE
Practice Address - Street 2:APT 5A
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507
Practice Address - Country:US
Practice Address - Phone:914-666-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY561315-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse