Provider Demographics
NPI:1699148833
Name:GESTOSO, EDITA (RN)
Entity type:Individual
Prefix:MRS
First Name:EDITA
Middle Name:
Last Name:GESTOSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 WABASH CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8848
Mailing Address - Country:US
Mailing Address - Phone:775-870-9312
Mailing Address - Fax:775-870-1340
Practice Address - Street 1:2612 WABASH CIR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8848
Practice Address - Country:US
Practice Address - Phone:775-870-9312
Practice Address - Fax:775-870-1340
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5747AGC-9310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility