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General NPI Number Information
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NPI Number | 1518599778
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Entity Type | Individual
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Provider Name | EVA MARIA GALLINA CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 4525 MID RIVERS MALL DR STE 110
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City | SAINT PETERS
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State | MO
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Zip | 63376-2820
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Country | US
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Telephone | 636-229-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 649 CHARLESTON OAKS DR
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City | BALLWIN
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State | MO
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Zip | 63021-7390
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Country | US
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Telephone | 314-401-4046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2019042613
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License Number State | MO
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