Provider Demographics
NPI:1336372820
Name:GAYLE, LAUREAL LEE (LPN)
Entity Type:Individual
Prefix:
First Name:LAUREAL
Middle Name:LEE
Last Name:GAYLE
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 1:914 MOTHER GASTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5708
Mailing Address - Country:US
Mailing Address - Phone:134-745-2002
Mailing Address - Fax:212-677-6971
Practice Address - Street 1:620 E 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3615
Practice Address - Country:US
Practice Address - Phone:212-674-5280
Practice Address - Fax:212-677-6971
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241895-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse