Provider Demographics
NPI:1588152383
Name:FROST, GENA
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11908 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2808
Mailing Address - Country:US
Mailing Address - Phone:516-325-3900
Mailing Address - Fax:
Practice Address - Street 1:11908 107TH AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMONDHILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1141
Practice Address - Country:US
Practice Address - Phone:917-651-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331782164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty