Healthcare Provider Details

I. General information

NPI: 1497095632
Provider Name (Legal Business Name): MARY LAURETTE GALLO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE GALLO

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 OPAL COMMONS ISLAND HOSPITAL
EASTSOUND WA
98245-9620
US

IV. Provider business mailing address

13 OPAL COMMONS
EASTSOUND WA
98245-9620
US

V. Phone/Fax

Practice location:
  • Phone: 360-302-0978
  • Fax: 360-376-5183
Mailing address:
  • Phone: 360-302-0978
  • Fax: 360-376-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN150147
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN150147
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberRN150147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: