Healthcare Provider Details

I. General information

NPI: 1447531330
Provider Name (Legal Business Name): GILLIAN LYNN KINGSLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 WESLEY RD
BLOOMFIELD NY
14469-9211
US

IV. Provider business mailing address

8080 WESLEY RD
BLOOMFIELD NY
14469-9211
US

V. Phone/Fax

Practice location:
  • Phone: 585-313-0557
  • Fax:
Mailing address:
  • Phone: 585-313-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number22648587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: