Provider Demographics
NPI:1821307653
Name:GAYESKI, ELAINE DUFFY (APRN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:DUFFY
Last Name:GAYESKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ELM ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3669
Mailing Address - Country:US
Mailing Address - Phone:860-714-9050
Mailing Address - Fax:
Practice Address - Street 1:7 ELM ST
Practice Address - Street 2:SUITE 307
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3669
Practice Address - Country:US
Practice Address - Phone:860-714-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE34998363LA2200X
CT004504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health