Provider Demographics
NPI:1447531330
Name:KINGSLEY, GILLIAN LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:LYNN
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9211
Mailing Address - Country:US
Mailing Address - Phone:585-313-0557
Mailing Address - Fax:
Practice Address - Street 1:8080 WESLEY RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NY
Practice Address - Zip Code:14469-9211
Practice Address - Country:US
Practice Address - Phone:585-313-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22648587163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22648587OtherTHE UNIVERISTY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT