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General NPI Number Information
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NPI Number | 1932876539
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Entity Type | Individual
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Provider Name | KERRI GAVAN LPN
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 24 ROBERTS ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-5042
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Country | US
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Telephone | 516-293-0054
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Fax |
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Provider Business Mailing Address
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Address Line | 267 SINGINGWOOD DR
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City | HOLBROOK
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State | NY
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Zip | 11741-2826
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Country | US
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Telephone | 631-404-7278
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 341035
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License Number State | NY
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