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General NPI Number Information
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NPI Number | 1790367084
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Entity Type | Individual
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Provider Name | CHANDRA JANELLE GALL CCP, LP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 350 7TH ST N
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City | NAPLES
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State | FL
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Zip | 34102-5754
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Country | US
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Telephone | 239-624-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 15TH AVE SW
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City | NAPLES
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State | FL
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Zip | 34117-5349
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Country | US
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Telephone | 574-276-0877
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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 | 242T00000X
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Taxonomy Name | Perfusionist
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License Number | 1000-00273
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License Number State | NC
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