MEDICARE: JUDY KAY GAL CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.025115	OH

General Provider Information

NPI Number	:	1023654035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY KAY GAL CNP

Provider Business Mailing Address
First Line	:	7118 HOLLY SPRINGS CT
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-9730
Country	:	US
Telephone Number	:	419-351-6730
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 N HOLLAND SYLVANIA RD STE 101
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3533
Country	:	US
Telephone Number	:	419-517-0146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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