MEDICARE: MRS. KATHLEEN L GALE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse		IL

General Provider Information

NPI Number	:	1346434701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN L GALE RN

Provider Business Mailing Address
First Line	:	5030 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2611
Country	:	US
Telephone Number	:	773-282-7932
Fax Number	:	773-282-7932

Provider Business Practice Location Address
First Line	:	5030 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2611
Country	:	US
Telephone Number	:	773-282-7932
Fax Number	:	773-282-7932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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