Healthcare Provider Details

I. General information

NPI: 1396040978
Provider Name (Legal Business Name): KIMBERLY R GALATI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY R MALON

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTHWESTERN DR LOWER LEVEL
BLOOMFIELD CT
06002-3444
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY STE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-5600
  • Fax:
Mailing address:
  • Phone: 571-777-5164
  • Fax: 703-890-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4577
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: