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General NPI Number Information
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NPI Number | 1235916768
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Entity Type | Individual
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Provider Name | LATESHA LARAE GASTON CERTIFIED NURSE AIDE
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Gender | Female
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 02/25/2024
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Provider Practice Location Address
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Address Line | 1416 HOWARD AVE
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City | UTICA
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State | NY
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Zip | 13501-4504
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Country | US
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Telephone | 680-217-1952
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Fax |
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Provider Business Mailing Address
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Address Line | 1416 HOWARD AVE
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City | UTICA
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State | NY
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Zip | 13501-4504
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Country | US
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Telephone | 315-316-4499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 343882291016E
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License Number State | NY
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