Provider Demographics
NPI:1588388763
Name:CONTORNO-GASTON, BRIAN EDWARD (LPN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:CONTORNO-GASTON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 BURNS DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5975
Mailing Address - Country:US
Mailing Address - Phone:808-445-1966
Mailing Address - Fax:
Practice Address - Street 1:318 BURNS DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5975
Practice Address - Country:US
Practice Address - Phone:808-445-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN095122164W00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse