Provider Demographics
NPI:1659798569
Name:GARY, MAKEISHA (LPN)
Entity Type:Individual
Prefix:
First Name:MAKEISHA
Middle Name:
Last Name:GARY
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 1:3316 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2057
Mailing Address - Country:US
Mailing Address - Phone:216-882-7236
Mailing Address - Fax:
Practice Address - Street 1:3316 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2057
Practice Address - Country:US
Practice Address - Phone:216-882-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143810164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse