Provider Demographics
NPI:1720413313
Name:INNISS, GISSELLE T (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GISSELLE
Middle Name:T
Last Name:INNISS
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 1:1454 WALTON AVE
Mailing Address - Street 2:APT 1J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-6564
Mailing Address - Country:US
Mailing Address - Phone:347-630-6823
Mailing Address - Fax:
Practice Address - Street 1:1454 WALTON AVE
Practice Address - Street 2:APT 1J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-6564
Practice Address - Country:US
Practice Address - Phone:347-630-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316167164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse