Healthcare Provider Details

I. General information

NPI: 1487057436
Provider Name (Legal Business Name): MARIA LOURDES GALVAN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 86 & TOPAWA RD.
SELLS AZ
85634-0548
US

IV. Provider business mailing address

PO BOX 548
SELLS AZ
85634-0548
US

V. Phone/Fax

Practice location:
  • Phone: 520-383-7332
  • Fax: 520-383-7343
Mailing address:
  • Phone: 520-383-7332
  • Fax: 520-383-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN146982
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: