Individual
AMANDA G GLEASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2375 MOTOR PKWY, RONKONKOMA, NY 11779-4724
(631) 672-3886
Mailing address
2375 MOTOR PKWY, RONKONKOMA, NY 11779-4724
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
327753
NY
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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