Provider Demographics
NPI:1801338249
Name:GLEASON, CAROL ANN (LPN)
Entity type:Individual
Prefix:
First Name:CAROL ANN
Middle Name:
Last Name:GLEASON
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 1:373 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1821
Mailing Address - Country:US
Mailing Address - Phone:914-395-1955
Mailing Address - Fax:
Practice Address - Street 1:3 COTTAGE PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4201
Practice Address - Country:US
Practice Address - Phone:914-235-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse