Provider Demographics
NPI:1316269442
Name:RODRIQUEZ, GLORIA K (LPN)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:K
Last Name:RODRIQUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E SUMMERSET LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1609
Mailing Address - Country:US
Mailing Address - Phone:716-510-0871
Mailing Address - Fax:
Practice Address - Street 1:12 E SUMMERSET LN
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1609
Practice Address - Country:US
Practice Address - Phone:716-510-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282477-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse