Provider Demographics
NPI:1386976603
Name:MAGLOIRE-GATTEREAU, DOMINIQUE R (LPN)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:R
Last Name:MAGLOIRE-GATTEREAU
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 1:674 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3920
Mailing Address - Country:US
Mailing Address - Phone:516-924-3275
Mailing Address - Fax:516-208-8152
Practice Address - Street 1:674 THOMAS AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3920
Practice Address - Country:US
Practice Address - Phone:516-924-3275
Practice Address - Fax:516-208-8152
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211550-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse