Provider Demographics
NPI:1174741177
Name:GATES, CRISTI LYNNE
Entity type:Individual
Prefix:
First Name:CRISTI
Middle Name:LYNNE
Last Name:GATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISTI
Other - Middle Name:LYNNE
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:7 ASH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1355
Mailing Address - Country:US
Mailing Address - Phone:740-501-2198
Mailing Address - Fax:
Practice Address - Street 1:7 ASH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1355
Practice Address - Country:US
Practice Address - Phone:740-501-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 114978164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse