Provider Demographics
NPI:1811179914
Name:GATES, LIANNA (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:LIANNA
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 NORWAY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-9331
Mailing Address - Country:US
Mailing Address - Phone:585-233-5787
Mailing Address - Fax:585-659-8209
Practice Address - Street 1:2658 NORWAY RD
Practice Address - Street 2:
Practice Address - City:HOLLEY
Practice Address - State:NY
Practice Address - Zip Code:14470-9331
Practice Address - Country:US
Practice Address - Phone:585-233-5787
Practice Address - Fax:585-659-8209
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576026-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY576026-1OtherNYS RN LICENCE