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General NPI Number Information
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NPI Number | 1720572878
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Entity Type | Individual
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Provider Name | GALAXIE GAVIN NP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 100 W 162ND ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2003
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Country | US
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Telephone | 708-730-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209017779
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209017779
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277003010
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License Number State | IL
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