Healthcare Provider Details

I. General information

NPI: 1659595833
Provider Name (Legal Business Name): KATHY LEE GASKILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 BOYDEN AVE
MAPLEWOOD NJ
07040-2480
US

IV. Provider business mailing address

84 FENWICK RD
AUGUSTA NJ
07822-2118
US

V. Phone/Fax

Practice location:
  • Phone: 973-378-6073
  • Fax: 973-378-6435
Mailing address:
  • Phone: 973-875-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberNR08795300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: