Provider Demographics
NPI:1508138611
Name:GATES, MIKKA C (RN)
Entity Type:Individual
Prefix:
First Name:MIKKA
Middle Name:C
Last Name:GATES
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 1:14 ERIE ST N
Mailing Address - Street 2:APT A
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8827
Mailing Address - Country:US
Mailing Address - Phone:315-879-2171
Mailing Address - Fax:
Practice Address - Street 1:4573 MAYFLOWER DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9744
Practice Address - Country:US
Practice Address - Phone:585-430-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY757010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse