Healthcare Provider Details

I. General information

NPI: 1629246095
Provider Name (Legal Business Name): GALENA DARNELLA JUREK NURSING ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 301, ANDREWS AVE. LYSTER ARMY HEALTH CLINIC
FORT RUCKER AL
36362-5333
US

IV. Provider business mailing address

BLDG 301, ANDREWS AVE. LYSTER ARMY HEALTH CLINIC
FORT RUCKER AL
36362-5333
US

V. Phone/Fax

Practice location:
  • Phone: 334-255-7048
  • Fax: 334-255-7368
Mailing address:
  • Phone: 334-255-7048
  • Fax: 334-255-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: