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General NPI Number Information
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NPI Number | 1235315276
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Entity Type | Organization
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Legal Business Name | LAUREEN GALLO INC
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Dates
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Enumeration Date | 01/20/2008
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Last Update Date | 01/20/2008
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Provider Practice Location Address
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Address Line | 12417 OCEAN GTWY A6
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City | OCEAN CITY
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State | MD
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Zip | 21842-9521
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Country | US
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Telephone | 410-213-7937
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Fax | 410-213-7939
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Provider Business Mailing Address
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Address Line | 12417 OCEAN GTWY A6
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City | OCEAN CITY
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State | MD
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Zip | 21842-9521
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Country | US
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Telephone | 410-213-7937
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Fax | 410-213-7939
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Authorized Official
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Title or Position | OWNER
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Name | MS. LAUREEN GALLO
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Credential | CRNP
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Telephone | 410-213-7937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0001194155
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License Number State | VA
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