Healthcare Provider Details

I. General information

NPI: 1619667656
Provider Name (Legal Business Name): ASHLEY RAE GALLINA APRN, CNM, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 STATE PARK RD
FOX LAKE IL
60020-1027
US

IV. Provider business mailing address

7227 STATE PARK RD
FOX LAKE IL
60020-1027
US

V. Phone/Fax

Practice location:
  • Phone: 815-363-2020
  • Fax: 949-703-8263
Mailing address:
  • Phone: 815-363-2020
  • Fax: 949-703-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209024423
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.031083
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: