Provider Demographics
NPI:1760979876
Name:GATES, ROTONIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ROTONIA
Middle Name:
Last Name:GATES
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 1:2139 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6207
Mailing Address - Country:US
Mailing Address - Phone:855-477-1372
Mailing Address - Fax:
Practice Address - Street 1:2139 8TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6207
Practice Address - Country:US
Practice Address - Phone:855-477-1372
Practice Address - Fax:855-640-5048
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS327534164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse