Provider Demographics
NPI:1154515799
Name:KEITT, GLORIA JEAN I (LICENSED NURSE)
Entity type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:JEAN
Last Name:KEITT
Suffix:I
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WEEGER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-1350
Mailing Address - Country:US
Mailing Address - Phone:585-546-4508
Mailing Address - Fax:
Practice Address - Street 1:14 WEEGER STREET
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605
Practice Address - Country:US
Practice Address - Phone:585-546-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241424164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse