Provider Demographics
NPI:1578860516
Name:GILBO, SAMANTHA MAY (LPN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MAY
Last Name:GILBO
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 1:24635 BUSH RD
Mailing Address - Street 2:
Mailing Address - City:CALCIUM
Mailing Address - State:NY
Mailing Address - Zip Code:13616-3112
Mailing Address - Country:US
Mailing Address - Phone:315-786-8056
Mailing Address - Fax:
Practice Address - Street 1:21107 RT 12F
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269081164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse