Healthcare Provider Details

I. General information

NPI: 1861842882
Provider Name (Legal Business Name): DEBRA GALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N82W15340 APPLETON AVE
MENOMONEE FALLS WI
53051-3777
US

IV. Provider business mailing address

N82W15340 APPLETON AVE
MENOMONEE FALLS WI
53051-3777
US

V. Phone/Fax

Practice location:
  • Phone: 262-255-5754
  • Fax: 262-255-5429
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: