Healthcare Provider Details

I. General information

NPI: 1023258332
Provider Name (Legal Business Name): KRIS L GALLINA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROGRESS POINT CT
O FALLON MO
63368-2208
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8054
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-1065
  • Fax: 636-344-1064
Mailing address:
  • Phone: 636-344-1065
  • Fax: 636-344-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2003013752
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: