Provider Demographics
NPI:1558588152
Name:ZAKASHEFSKI, GLORIA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANN
Last Name:ZAKASHEFSKI
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:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:MARION HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:17832-0084
Mailing Address - Country:US
Mailing Address - Phone:570-373-5683
Mailing Address - Fax:
Practice Address - Street 1:117 W. NORTH STREET
Practice Address - Street 2:
Practice Address - City:MARION HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:17832
Practice Address - Country:US
Practice Address - Phone:570-373-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN266794164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse