Provider Demographics
NPI:1932407822
Name:GILLETTE, MEGHAN E (LPN)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:GILLETTE
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 1:25 SHADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-1518
Mailing Address - Country:US
Mailing Address - Phone:585-478-6727
Mailing Address - Fax:
Practice Address - Street 1:19 COURT ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3310
Practice Address - Country:US
Practice Address - Phone:914-946-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12345678164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03261983OtherLPN