Provider Demographics
NPI:1013128529
Name:GARLETT, EILEEN FRANCES (LPN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:FRANCES
Last Name:GARLETT
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 1:10 AMHERST AVENUE
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1849
Mailing Address - Country:US
Mailing Address - Phone:518-222-4841
Mailing Address - Fax:518-580-9521
Practice Address - Street 1:10 AMHERST AVENUE
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1849
Practice Address - Country:US
Practice Address - Phone:518-222-4841
Practice Address - Fax:518-580-9521
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260924164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBM85738ZMedicaid