Provider Demographics
NPI:1487109849
Name:GEKOSKI, AMANDA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:GEKOSKI
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 1:75 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2059
Mailing Address - Country:US
Mailing Address - Phone:585-721-1846
Mailing Address - Fax:
Practice Address - Street 1:75 HIGH ST
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2059
Practice Address - Country:US
Practice Address - Phone:585-721-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325538164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse