Provider Demographics
NPI:1811335359
Name:GAUSE, ANGELA COSTELLA (LPN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:COSTELLA
Last Name:GAUSE
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 1:255 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1349
Mailing Address - Country:US
Mailing Address - Phone:585-709-0224
Mailing Address - Fax:
Practice Address - Street 1:255 SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1349
Practice Address - Country:US
Practice Address - Phone:585-709-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10304272164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse