Healthcare Provider Details

I. General information

NPI: 1366725574
Provider Name (Legal Business Name): GAYLE LYNN VINETTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S MAIN ST
NORTH SYRACUSE NY
13212-3105
US

IV. Provider business mailing address

205 S MAIN ST
NORTH SYRACUSE NY
13212-3105
US

V. Phone/Fax

Practice location:
  • Phone: 315-218-2203
  • Fax: 315-218-2285
Mailing address:
  • Phone: 315-218-2203
  • Fax: 315-218-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number424041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: