Healthcare Provider Details

I. General information

NPI: 1780835264
Provider Name (Legal Business Name): ANNEMARIE GALIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

800 S 3RD ST APT C2
GALLUP NM
87301-5872
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax: 505-722-1310
Mailing address:
  • Phone: 215-480-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1014150
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: