Provider Demographics
NPI:1891034211
Name:GATTIS, LARANDA MICHELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LARANDA
Middle Name:MICHELLE
Last Name:GATTIS
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 1:809 VINE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1761
Mailing Address - Country:US
Mailing Address - Phone:573-344-1291
Mailing Address - Fax:
Practice Address - Street 1:946 E REED ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1243
Practice Address - Country:US
Practice Address - Phone:573-359-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008024023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse