Provider Demographics
NPI:1477365146
Name:YEATES, GENA (LPN)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:YEATES
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 1:129 GREENHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5509
Mailing Address - Country:US
Mailing Address - Phone:716-730-1522
Mailing Address - Fax:
Practice Address - Street 1:129 GREENHAVEN TER
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5509
Practice Address - Country:US
Practice Address - Phone:716-730-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352351-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse